Disease Search

Welcome to the Virtual Medical Centre (VMC). The VMC team spends a lot of time researching the diseases presented here and making sure that the information we provide has come from reputable peer-reviewed sources.

The quality of the content you see here is monitored by our editorial advisory board which consists of medical professionals. This means that you can be confident that whatever you read here is comprehensive, supported by real evidence and presented for your wellbeing.

The Virtual Medical Centre doesn?t aim to replace your doctor, its purpose is to provide supplementary information to demystify your health and help you to make educated decisions. We hope you find the information here useful and we wish you good health.

For more information about Virtual Medical Centre, see About Us.

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Abdominal Bloating

 

Abdominal bloating is felt by patients as a feeling of fullness, tightness or distension in the abdomen. Bloating is different to abdominal swelling, where the abdomen is actually increased in size, although both of these features may be present. 

Abdominal bloating is quite common and in the majority of cases will not be caused by anything serious. Excessive gas due to dietary factors, irritable bowel syndrome (IBS) or difficulty absorbing certain foods are amongst the most common causes. If your abdominal bloating is prolonged, severe, or if you have other worrying symptoms (e.g. diarrhoea, constipation, weight loss or bleeding) it is extrememly important you see your doctor so they can exclude serious conditions (e.g. cancer).

Abdominal bloating refers to a sensation of fullness or a sense of abdominal enlargement. It is often due to disturbance in the normal function of the gastrointestinal tract, causing an increase in intestinal gas.

Gas in the intestine is a mixture of numerous different components which can be increased by swallowing too much air, excess production, or impaired absorption due to obstruction. Excess gas causes bloating as well as other gas symptoms such as flatulence or burping.

If the abdomen is visibly distended in association with bloating, it is more likely that there is an organic, rather than functional, cause of the symptom. Bloating is frequently associated with abdominal pain that may be relieved by passing gas or bowel motions.

Abdominal bloating may be a feature of a number of disorders, the majority of which are not serious and result from changes in gastrointestinal function. Possible common causes are:

Diet

Your body takes a long time to break down and expel fat from the body. Too much fat in your diet can cause episodes of bloating. Other foods can cause bloating due to the formation of extra gas. These foods include cabbage, cauliflower, baked beans and salads.

Malabsorption syndromes

A number of disorders exist where the body cannot break down and absorb certain components of food. In these cases, the remaining food products can produce extra gas due to certain chemical reactions, or due to the good bacteria in the bowel trying extra hard to break these foods down. Lactose intolerance, coeliac disease and other food intolerances are examples of disorders that cause bloating by these mechanisms.

Air swallowing

If you swallow large amounts of air, your bowel has trouble absorbing or removing it all from the body fast enough. This means more will stay within the bowel lumen and cause the sensation of a full bowel. Anxiety or nervousness, eating quickly, gulping food or beverages, drinking through straws and chewing gum can all cause you to swallow increased amounts of air.

Irritable bowel syndrome 

Irritable bowel syndrome is a common disorder where patients have alternating episodes of constipation and diarrhoea. Abdominal bloating is one of the key features of this diagnosis.

Partial bowel obstruction

A blockage at some point in the intestines will impair the mechanical transit of food and may lead to bloating.

Constipation

Constipation is characterised by a reduction in the frequency of bowel motions, and may cause bloating.

Menstruation

Bloating is common in women at the time of menstruation, or as part of a premenstrual stress disorder.

Other causes

Very rarely, your bloating may be due to a more serious condition, so it often pays to discuss your symptoms with a doctor. The following conditions are less common but don't want to be missed:

Ascites: Sometimes you may feel bloated due to the accumulation of fluid within the abdominal cavity, called ascites. This is often the result of liver disease. Tumours: Very occasionally, you may feel bloated because there is a tumour present within your abdomen, of the ovaries, liver, stomach or elsewhere. The present of a lump or swelling should alert you to the possibility of a tumour or cancer. Infection: Certain parasitic disorders can cause abnormal dilatations of the colon (megacolon) associated with symptoms of bloating.

If you experience abdominal bloating, it is important to see your doctor to make sure there is nothing serious present. In particular, if you have symptoms of diarrhoea, constipation, weight loss or bleeding from anywhere in the gastrointestinal tract (vomiting blood or bloody or dark stools), there is a greater possibility that something more serious is present rather than just a functional problem.

When you see your doctor, you should be prepared to answer detailed questions about:

Duration of the bloatingYour dietThe relationship of the bloating to certain foodsIf you're a female, any change in bloating during the menstrual cycleAny other associated symptomsAny past medical historyCurrent medications

Your doctor will then examine you, paying particular attention to palpating your abdomen for any masses or swelling. Your doctor will also tap your belly to identify any fluid present. Listening to bowel sounds can help your doctor determine if there is an obstruction. The doctor may perform a rectal examination if you have other bowel symptoms.

If your bloating is due to a functional problem, such as an inability to tolerate dairy products or wheat, examination is likely to be normal. Your doctor may suggest trials of certain diets to determine if it is a particular food triggering your symptoms.

Investigations are needed in some patients, particularly when the other serious symptoms are present. Your doctor may refer you for the following:

Radiography: Plain x-rays of your abdomen can tell if it is blocked in certain places. Ultrasound or CT scans: May be done if the doctor suspects ascites (fluids) or a mass. Colonoscopy: Involves inserting a long tube (with a light and a camera on the end of it) into the rectum (back passage). The doctor can then look at the inside of the bowels to make sure there are no tumours (e.g. colon cancer). Barium enema  

If a specific cause is suggested (e.g. lactose intolerance), special trial diets or further diagnostic testing (e.g. lactose tolerance test) may be required. Coeliac disease may be diagnosed by a series of blood tests looking for certain antibodies.

The treatment of bloating mainly depends on the underlying cause of the symptom. Your doctor would have performed a number of necessary tests to exclude serious problems. Treatment then focuses on a number of diet and lifestyle changes:

Avoid carbonated beverages. Avoid chewing gum as this predisposes to air swallowing. Avoid foods that are difficult to digest or that cause increased amounts of gas (e.g. brussel sprouts, cabbage, beans and lentils). Be careful of your sources of fibre. Patients with IBS often need increased amounts of fibre to relieve their symptoms, however, some types of fibre such as psyllium (in Metamucil) can exacerbate bloating. You should discuss your choice of fibre supplements with a pharmacist. Eat small, frequent meals at a reasonable pace (slowly). Drinking fennel tea may help your symptoms.

In some patients, over-the-counter medications such as simethicone, beano and activated charcoal can help gas symptoms. Your doctor may suggest a trial of some of these, but unfortunately they have only modest benefits and do not work in all patients.

For more information on nutrition, including information on types and composition of food, nutrition and people, conditions related to nutrition, and diets and recipes, as well as some useful videos and tools, see Nutrition. 

Abraczinskas D, Goldfinger SE. Intestinal gas and bloating [online]. Waltham, MA: UpToDate; 2006 [cited 25 July 2006]. Available from: URL link Glickman R. Abdominal swelling and ascites. In: Braunwald E, Fauci AS, Kasper DL, et al. Harrison's Principles of Internal Medicine (16th edition). New York: McGraw-Hill Publishing; 2006. [Book]Lehrer JK, Lichtenstein GR. Irritable bowel syndrome [online]. Omaha, NE: WebMD eMedicine; 2005 [cited 25 July 2006]. Available from: URL linkLongmore M, Wilkinson I, Rajagopalan S. Oxford Handbook of Clinical Medicine (6th edition). Oxford: Oxford University Press; 2004. [Book]Abdominal bloating [online]. Bethesda, MD: National Institutes of Health Medline Plus; 2004 [cited 25 July 2006]. Available from: URL link Szarka L, Levitt M. Belching, bloating and flatulence [online]. Bethesda, MD: American College of Gastroenterology; 2006 [cited 25 July 2006]. Available from: URL link

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Cardiac PET Scan (Positron Emission Tomography)

A Cardiac PET Scan is an investigation that uses the position of radioactive substances within the body to give an idea about its function. Those parts of the body that are the most active need energy, and the energy that it uses is sugar (also called glucose). A PET scan uses a specially created substance that the body thinks is sugar, and takes it up into the cells. This substance is called a 'tracer', and it is almost exactly like sugar, but has a small radioactive part attached to it.

A Cardiac PET Scan uses this same technique, but uses different tracers and some different techniques to get a good idea about the function and blood flow to the heart. Often it is combined with a CT scan so that the doctor can see both the structure and function of the heart.

PET scans work to identify the cellular changes that occur in the body during disease.

During a PET scan, the patient is given a substance called a tracer, typically a chemical found in the body (oxygen, glucose, nitrogen, fluorine) which has been tagged with a radioactive atom that breaks down quickly to release positrons. The most common tracer for normal, non cardiac, PET scans has a complicated name but is mostly known as FDG (which stands for 2-[18F]fluoro-2-deoxy-D-glucose). FDG is very similar to glucose (sugar).

Once in the body FDG travels to the area of the body that is using a lot of sugar and breaks it down. In breaking down, it releases a positron. This combines with an electron from the patient sending out radioactive waves.

These waves can be detected by the PET Scanner which converts the waves into electrical signals that can be analysed by a computer. The computer can then create images of the targeted tissue's function, in a colour code. Different colours or degrees of brightness on a PET image represent different levels of tissue or organ function. In the image to the right, areas that use more sugar, and so collect more of the radioactive substance, are shaded darker.

For example, because healthy tissue uses glucose for energy, it accumulates some of the tagged glucose, which will show up on the PET images. However, cancerous tissue, which uses more glucose than normal tissue because it is growing much faster, will accumulate more of the substance and appear brighter than normal tissue on the PET images.

Therefore PET scans are commonly used to detect cancer, as the scan will detect biochemical changes in the body associated with cancer as well as the extent of spread and the possible effective treatment. Functions of the brain may also be examined in association with patients with memory loss, suspected or known brain tumours or seizure disorders.

For a Cardiac PET Scan, a different tracer is used than in a normal PET scan because uptake of sugar is not a very helpful thing to measure for the heart. For cardiac PET scans, the most common tracers are a type of ammonia with a bit of radioactive material attached to it, a substance called Rubidium and a radioactive type of Fluorine.

PET scans are generally done in an outpatient setting and preparation is usually set by your doctor. The scan does require the patient to lie still for a period of time for up to two hours, so if you feel you may have a problem with this, please talk to your doctor.

Women who suspect they may be pregnant or are pregnant need to notify their doctor as this is a radioactive procedure and could have effects on an unborn foetus.

The PET scanner is a donut-ring shaped apparatus with an attached table that moves into the scanning ring. Initial scans may be done before you are taken into a special injection room where the tracer is administered, usually intravenously.

It will then take 30-90 minutes for the substance to travel through your body and accumulate. During this time you may be asked to rest quietly to allow the substance to travel through the body. You will then be asked to lie still on the scanner table and it will move in through the scanner ring.

During the scan, which can take from thirty minutes to two hours, you must lie very still to allow for clarity of the images. After the scan there are no restrictions to daily activity, but it is recommended you drink plenty of water to flush your system of the tracer.

PET scans are beneficial as they demonstrate the biochemical changes in the body, whereas a CT or MRI scans identify anatomical changes.

A PET Scan therefore helps to identify problems at the level of their activity and function, which might change long before any changes in body structure (such as a tumour) become apparent.

This allows for earlier diagnosis and more effective treatment of diseases such as cancer, and also more detailed imaging of other conditions. There is little risk involved with the intravenous administration of the radioactive "tracer" as the tracer has a short decay time of only a few hours and is quickly removed from the body.

A cardiac PET scan is useful because it can give very precise images, is not greatly affected by the fast changing blood flow in the heart and can give information about how much of the tracer ends up in different parts of the heart. This is important because it can give doctors information about damage to the heart, and show areas that may have problems with low amounts of blood flow.

The risks associated with a PET scan are very small, and are due to reactions to the radioactive "tracer" injected. The level of tracer given to a patient is very tiny, and the chances of a reaction occurring are incredibly low. PET scans can sometimes show areas of high activity which may be mistaken for cancers. Inflammatory conditions like rheumatoid arthritis or tuberculosis absorb a large proportion of the tracer, and so can cause confusing results.A PET scan is less accurate in certain situations: Slow-growing, less active tumours may not absorb much tracer.Small tumours (less than 7mm) may not be detectable.High levels of blood sugar can cause the cells to absorb this normal sugar rather than the radioactive, injected kind. Patients are usually fasted for 4 hours before a PET scan, and blood sugar levels measured to lower the chances of this happening.The radioactive substance has a very short decay and therefore appointments must run on schedule.PET scans are a very expensive form of imaging, and are not readily available. They often accompany other scans such as CT and MRI in order to be diagnostically effective.

After a PET scan, the doctor will receive an image of the patient displaying the different amounts of activity present in different parts of the body. An image of a combined CT Scan and PET scan is seen to the right. Different colours represent different levels of tracer and so can show different levels of blood flow.

For a normal PET scan, if there is cancer present in the body, this area will appear to be more active and so PET scans are often used to determine if a cancer has spread to other parts of the body, or to see how advanced a cancer is. A PET scan is not as accurate for very small cancers however, so very early scans may not show anything.

Cardiac PET scans could show a doctor that blood flow to the heart is completely normal but could also show that things are going wrong. The doctor would be looking for any parts of the heart that did not get an adequate amount of the tracer as this would show that it is also not getting enough blood.

Di Carli MF, Dorbala S. Integrated PET/CT for cardiac imaging. The Quarterly Journal of Nuclear Medicine and Molecular Imaging, 2006; 50, 1: 44.Positron Emission Tomography: Assessment Report. Medicare Services Advisory Committee, 2000. Commonwealth of Australia.Khorsand A, Graf S, Eidherr H, Wadsak W, et al. Gated Cardiac 13N-NH3 PET for Assessment of Left Ventricular Volume. The Journal of Nuclear Medicine, 2005; 46 (12): 2009.Soben P, Udelson KE. 'Thoracic Assessment of myocardial viability by nuclear imaging in coronary heart disease' [online], UpToDate, 2006. Available at URL: http://www.uptodate.com (last accessed 13/07/06)Stark P. 'Thoracic positron emission tomography' [online], UpToDate, 2006. Available at URL: http://www.uptodate.com (last accessed 13/07/06)



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Gastroplasty

Gastroplasty is a weight loss operation available for the management of morbid obesity. It is a restrictive procedure in that it limits and reduces the amount of food intake possible, as opposed to the alternative procedures such as gastric bypass which work by reducing the absorption of calories through the digestive tract. Its main advantage is that is does not affect the normal digestive process, thereby limiting nutritional deficiencies which are often associated with the former procedure.

This procedure is also known as ‘stomach stapling’ as it involves vertically stapling the upper part of the stomach into a small pouch of about 20-30mL which is then connected to the rest of the stomach through an small outlet (stoma) of about 10-12mm width. At the lower end of the pouch a band or mesh is often placed to prevent the outlet from widening. The pouch restricts the amount of food that can be eaten at one time because of the slow passage of the food into the remaining stomach which subsequently helps maintain a feeling of fullness.

Gastroplasty was initially introduced in 1971 following the advent of surgical staples and was supposedly to provide a simpler and safer alternative to gastric bypass surgery which was often associated with many complications such as micronutrient deficiency and peptic ulcerations. It has had several revisions made to it since its introduction. The earliest methods involved horizontal stapling of the stomach which divided it into a smaller upper section and larger lower part which was connected by a channel. However this was unsuccessful in maintaining weight loss because of inevitable stomal widening. In 1981 vertical gastroplasty was introduced and again initial methods resulted in breakdown of staples and stomal enlargement and were soon modified by the addition of a band or silastic ring around the stoma to support the outlet and prevent it from stretching. This modification was known as vertical banded gastroplasty (VBG) and is what is what is used today.

VBG can be carried out as open surgery or laparoscopically. The first laparoscopic VBG was performed in 1993 and is now more commonly performed because of the reduction in complications associated with wounds such as infection and incisional hernias.

Gastroplasties are becoming less widely used now with the introduction of the adjustable gastric banding technique which is simpler and avoids incision of the stomach and the use of staples. World-wide VBGs comprise around 5% of all weight loss operations, thus making it the third most common surgery for obesity. In Australia however, it is performed with much less frequency due to it's high long term re-operation rate of about 20%. In Australia the most common procedure is laparoscopic adjustable gastric banding (LABG) which is carried out in more than 90% of cases.

Weight-loss surgery is performed to aid morbidly obese patients lose weight, as their weight often impacts significantly on their health and state of mental well being. Often they will also be suffering from other life threatening or debilitating illnesses such as heart disease, diabetes, depression, sleep apnoea and osteoarthritis.

The suitability of a patient for gastroplasty is essentially the same as for all weight-loss surgeries. Certain guidelines are set by the National institutes of health (NIH) and the National Health and Medical Research Council (NHMRC) which outline selection criteria that must be taken into consideration before a doctor can recommend weight loss surgery:

Weight greater than 45kg above ideal body weight for sex, and height. Body mass index (BMI) greater than 40 by itself or greater than 35 if there is an associated obesity illness, such as diabetes or heart diseaseSeveral previous attempts already made using other non-surgical weight loss techniques Aged between 18-65 yearsHas been at current weight for 3-5 yearsHas obesity related health problems  No drug and alcohol dependency problems or major psychiatric illnessCapable of tolerating surgeryunderstands the risks and long term commitment associated with the surgery. Patient motivation and willingness to commit to behavioural and lifestyle changes following surgery and is committed to long term follow up.Is not pregnant and not planning a pregnancy within the first two years after surgery

This tool needs Javascript enabled to run.

The formula for calculating your body mass index is:
BMI = weight (kilograms) / (height (metres) * height (metres))

For example:
A man who weighs 85 kilograms and is 1.8 metres tall would have a BMI of
BMI = 85 / (1.8 * 1.8)
BMI = 85 / 3.24
BMI = 26.2

This information will be collected for educational purposes, however it will remain anonymous.

Click here to calculate your BMI.

There are some exceptions to this and patients as young as 12 have been offered surgery. Sometimes a lower BMI of 30-35 is accepted if a patient is also suffering from hypertension, diabetes mellitus, hyperlipidema, severe osteoarthritis or sleep apnoea.

Gastroplasty is generally a quick and safe procedure in comparison to many of the other weight loss operations and now with laparoscopic method available also reduces the risk of certain complications. It also has a very low mortality rate in comparison to other surgeries. The procedure is reversible as the digestive tract is left intact and there is also less risk of infection.

Because gastroplasty does not involve alterations of the anatomy of the gastrointestinal tract there are no effects of such as those seen in malabsorption surgeries. Nutritional deficiencies such as anaemia are uncommon with less than 3% of those undergoing VGB experiencing deficiencies as opposed to 17% patients with gastric bypass. In addition, maintaining a normal anatomy also allows passage of an endoscope if necessary later on.

As with most bariatric surgeries the resulting weight loss can help reduce the effects of co-morbidities such as cardiovascular disease, hypertension and diabetes. One study found it reduced the risk of cancer incidence.

VBG is losing favour over other forms of bariatric surgery, mainly because it has been the least successful in maintaining weight loss long-term. It is also the procedure which produces less weight loss initially. VBG patients can lose about 40-50% of their excess body weight over the first two years but this drops to 20% after three years. Several studies have found that patients undergoing gastroplasty lose around 10kg less than those undergoing with Roux-en-Y Gastric Bypass (RYGB) at 12 and 36 months post surgery with the average weight loss around 32 kg compared to 42kg for gastric bypass. The main contributing factors to late weight gain are expansion of the pouch, staple line breakdown and migration of the band supporting the outlet.

Following surgery patients are required to adhere to a very strict diet and must follow advice on how to eat food to avoid problems. Reversal of gastroplasty is carried out in about 4% of patients because of food intolerance. Vomiting and severe discomfort is experienced if food is not properly chewed or if food is eaten too quickly.

Maladaptive eating behaviours can occur which also contributes to weight gain. One such behaviour is the ‘soft calorie syndrome’ where patients tend to ingest ice-cream and high calorie soft drinks which easily pass through the narrow outlet from the pouch. Highly refined foods also tend to be easier to eat while high fibre foods such as fruit and vegetables are very difficult so many patients slowly regain weight lost after surgery by consuming more calorie rich foods.

VBG is not adjustable like gastric banding, however it can be reversed or converted to a gastric bypass.

Complications

The most common complications associated with VBG are obstruction, leakage from the stomach, outlet stenosis, pouch dilatation, ulcers, incisional hernia, fistulas, wound infections, band erosion, staple line disruption and bleeding from the staple line and rarely, pulmonary complications.

Stenosis may occur from infection of the material supporting the stoma or a reaction of the scar tissue around it. It may manifest as deterioration of ability to eat solid food and regurgitation. Heartburn is a consequence of this and patient may have to resort to a liquid diet.
Leakage from the stomach usually manifests as tachycardia with severe abdominal pain and a subsequent increase in body temperature. Patients may experience difficulty breathing and pain in the left shoulder.

Thromboembolic disease in not common but can be life threatening. To avoid this, patients should be encouraged to get up and walk around early on after surgery. Other preventative measures that may be taken include administration of low dose heparin for the duration of the hospital stay.

Mortality associated with VBG is very low (0-1.7%) with pulmonary embolus being most common cause of death. Mortality is also related to the experience of the surgeon.

Generally, laparoscopic procedures require a shorter recovery time and have a reduced incidence of wound infection and incisional hernias compared with open surgery. However, it appears that the re-operation rate is higher with laparoscopic procedures.

Long term complications

A ten year follow-up study found that the most common long term complications were, staple line disruption, mechanical or functional stomal obstruction and maladaptive eating behaviours. A high incidence of persisent vomiting, heartburn and dumping is also common. Most importantly only 26% of patients maintained weight loss after ten years.

Late complications that require re-operation include the onset of gastroesophageal reflux, staple line fistula, food intolerance, pouch enlargement and incisional hernias.

Evaluating a patient who is interested in bariatric surgery is complex and often involves collaborations between the surgeon, a nutritional specialist and a psychologist. A patient’s medical history and a full physical examination is conducted in order to identify any risk factors such as hypertension, type 2 diabetes and hypoventilation syndrome. A dietician is also involved in assessing a candidate’s relationship with food and eating behaviours. Patients need to be well informed of all aspects of the procedure including the risks, benefits, side effects, and expected weight loss. Particular emphasis must be placed on the importance of making permanent dietary and lifestyle changes to ensure long-term the success of the surgery and to reduce the chance of weight gain and other complications. Patient motivation and willingness to adhere to all post-operative dietary recommendations is the key to ensuring long term successful weight loss.

Surgeons can only do so much and the rest is up to the patient. They must be willing to modify their eating habits and understand the effects on eating techniques following surgery.

VBG is performed under general anaesthetic and takes about one hour. The procedure involves making a hole in both layers of the stomach with a circular stapling device to create an opening through which a stapler could be passed. The stomach is then divided using staples to create a small pouch closest to the oesophagus. The end of the pouch is narrowed to create a small outlet of about 10-12mm width which leads into the remainder of the stomach. This outlet is reinforced with a silastic ring which prevents it from stretching.

Following gastroplasty surgery, patients will feel full after eating only small amount of food and also stay full longer thus leading to a drastic reduction in calorie-intake. Most weight loss occurs in the first six-months to a year following surgery. Further success is dependant on a patient’s compliance with a strict diet and exercise regime.

Usually patients can be discharged from the hospital 3-4 days after surgery. If a laparoscopic procedure was performed then they may be able to leave even earlier.

In order to prevent discomfort and complications patients are required to follow a very strict diet, especially in the weeks after surgery. It is recommended that only liquids are ingested in the first 1-2 weeks post surgery followed by soft pureed food for three more weeks before commencing on solids. Patients are advised on the correct technique when eating such that obstruction does not occur.

Those adhering to strict follow-up and regular monitoring with their surgeon and dietician are more likely to have successful outcomes. A strict eating plan and exercise regime should be made early on and commenced immediately following discharge.

Eating and drinking at the same time should be avoided as food will be washed down into the distal stomach and the feeling of fullness will not be achieved.

Ultimately it is up to the patient to ensure long term success of their surgery. They must be willing and motivated to comply to all dietary and lifestyle changes recommended. Ongoing social and psychological support will be necessary in achieving this.

For more information on obesity, health and social issues, and methods of weight loss, as well as some useful tools, see Obesity and Weight Loss.  Wright AJ, Sudan R and Forse AR. A clinical guide in the management of overweight and obese children and adults. In: Surgical Treatment of Obesity. Ch7 p123-139Bult MJF, van Dalen T and Muller AF. Surgical treatment of obesity. European Journal of Endocrinology. 2008; 158(2); p. 135-145.Schweitzer M, Lidor A and Magnuson T. Bariatric surgery. In: Health and treatment strategies in obesity. Advances in psychosomatic medicine. Vol 27; p. 53-60. Editor: Vaidya V. Switzerland; S. Karger AG. 2006.Jamieson AC. Vertical banded gastroplasty. In: Surgical management of obesity. p.167-176. Editors: Buchwald H, Cowan GSM and Pories WJ. Philadelphia: Elsevier Saunders. 2007.Maggard MA, Shugarman LR, Suttorp S,  Maglione M et al. Meta-analysis: surgical treatment of obesity. Annals of Internal Medicine 2005; 142(7); p. 547Champion JK and Williams M. Laparoscopic vertical banded gastroplasty. In: Surgical management of obesity. p.177-184. Editors: Buchwald H, Cowan GSM and Pories WJ. Philadelphia: Elsevier Saunders. 2007.North-eastern Weight Loss Surgery. Obesity Surgery Melbourne. Vertical banded gastroplasty. Available online: http://melbourneobesitysurgery.com.au/vertical_gastroplasty.html. Accessed 20 March 2008.National Health and Medical Research Council. (2003). Clinical practice guidelines for the management of overweight and obesity in Australia [update 19th March 2004] Commonwealth of Australia, Department of Health and Ageing.
Available online: www.obesityguidelines.gov.auUS National Institutes of Health. Clinical guidelines on the identification,evaluation and treatment of overweight and obesity in adults: executive summary. Expert Panel on the Identification, Evaluation and Treatment of Overweight in Adults. Am J Clin Nutr; 1998; 68(4); p. 899–917.Mason E. Development and future of gastroplasties for morbid obesity. Archives in Surgery; April 2003; 38Colquitt, J. Clegg, A. Loveman, E. Royle, P. Sidhu, M. (2005). Surgery for morbid obesity. Cochrane clinical review. Available online: [http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003641/frame.htmlBalsiger BM, Poggio JL, Mai J, Kelly KA and Sarr MG. Ten and more years after vertical banded gastroplasty as primary operation for morbid obesity. Journal of Gastro-intestinal Surgery 2000; 4(6); p. 598-605.

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Gastric Banding

Gastric banding is an operation performed under general anaesthetic. A surgeon will place an adjustable band around the top of the stomach to create a small pouch to hold food. The band is attached via a thin tube to a small "port" or reservoir, which is placed under the abdominal skin at the time of surgery. This port allows the surgeon to increase the tightness of the band (by injecting fluid into the reservoir) at a later stage. In Australia, laparoscopic (key-hole surgery) is the most common method used to perform gastric banding. This procedure is considered simple and safe for people who are very overweight and experience complications because of their weight.

Surgery is considered to help morbidly obese patients lose weight. This is because a person who is obese is more likely to suffer from physical and psychological illness than a healthy weight person. In particular, overweight patients are more at risk of heart disease, diabetes, high blood pressure, high cholesterol, heart attacks or stroke, sleep apnoea, depression, and osteoarthritis. Losing weight has been shown to reverse or reduce these conditions. Laparoscopic gastric banding is performed on people who are morbidly obese. This means they have a Body Mass Index (BMI) of more than 40. (The normal BMI is 18.5 - 24.9. Calculate your own BMI here.) A person's weight is not the only consideration in having this procedure. Some people who have a BMI of 35 or more may be considered if they also have medical problems such as heart disease, diabetes, high blood pressure, high cholesterol or severe arthritis. Before a person can be considered for surgery, they must have made multiple, previous significant attempts to lose weight on their own. This includes dieting, exercise, and possibly medications for aiding weight loss. Most surgeons require a patient to show they are motivated to lose weight before they have surgery. If a person is highly motivated they are more likely to follow their specialised eating plan and attend regular follow-up after surgery.

Gastric banding creates a small pouch before the stomach in which food becomes trapped when it is ingested. The benefit of this is there is a smaller capacity for solid food to be held and a person will feel full more quickly. Food in the pouch is digested more slowly and so a person's sense of "fullness" can last longer after meals. Studies have shown that this procedure cause an average of 23kg of weight loss at 2 years, and up to 43kg of weight loss at 5 years. Most patients who try to lose weight without this surgery do not lose any weight at all over a long period. Laparoscopic banding surgery is considered the safest of all the types of surgery performed to reduce weight. In most cases, patients will only be in hospital for 24 hours. After surgery, there is an improvement in many obesity related diseases. Studies 2 years after the laparoscopic banding procedure have shown improvements in;

Blood pressureCholesterolAsthmaDiabetesGastro-oesophageal refluxHeart failureSleep apnoeaDepressionInfertilityBlood clots

Laparoscopic gastric banding surgery is more complex to perform than some other types of surgery. However most surgeons who perform this operation are highly experienced. The surgeon who performs this procedure should discuss the complications with you prior to the operation. The overall rate of complications is also low. There is a very low risk of death with this operation, less than 0.5%. As with any form of surgery, there is a small risk of infection, wound problems, blood clots or lung problems. There are measures to minimise these complications that your doctor may prescribe. There is a risk of the band slipping or the pouch dilating. These problems may require further surgery in about 25% of cases. In less than 2% of people there is a risk that the band may erode into the stomach lining. After the surgery, some patients can have vomiting related to eating. This does not happen in all patients and can be reduced by eating small portions. This procedure is not always successful. A small number of patients will not lose weight with this surgery. However, in those patients who lose weight rapidly, there is a risk that they can develop gallbladder inflammation, which may require removal of the gallbladder.

A person is usually referred to see a surgeon by their GP. The surgeon will discuss the procedure, its risks and benefits. There are also a number of criteria a patient should meet. The person should have a BMI of more than 40. In some situations a person with a lower BMI may be considered for surgery if they have medical problems such as high blood pressure or diabetes. To be eligible a person must also have made multiple, significant attempts to lose weight on their own. There are a number of professionals that form a team to look after patients who have gastric banding surgery. The team may include nurses, a dietician, social worker, physiotherapist and anaesthetist. A person will have to attend multiple appointments with these professionals. In most cases a person will need to see at least the surgeon, dietician and anaesthetist, prior to surgery. Many centres also ask patients to see a psychologist before they are considered for surgery. The role of the psychologist is to interview the patient and discuss emotional and social factors, which might influence their ability to lose weight. Their involvement is important to help identify those people who will do well, or not-so-well following this surgery. After surgery, a person will attend follow-up sessions with many health professionals. It is important to understand prior to surgery that long-term follow-up is a part of the treatment plan.

The laparoscopic gastric banding surgery involves an adjustable silicone band being placed around the top portion of the stomach. During this procedure, a person will be kept asleep by a general anaesthetic. The surgeon will use several small probes to introduce the band into the abdomen and then place it around the top portion of the stomach. There will be several small cuts on the surface of the abdomen from the probes used. Attached to the silicone band is a small port or reservoir, which will be inserted under the skin at the time of surgery. The person will be able to feel a lump under the skin where the port is situated. This port will allow the surgeon to adjust the tightness of the band at a later stage.

After the surgery, a patient will wake up either in the operating room or just outside. It can take a few hours to feel back to normal after an anaesthetic. In most cases, a person will be ready to return home a day after surgery. It is advisable that a family member or friend be available to pick a patient up from hospital and stay with them for the first 24 - 48 hours. It is expected that you may be a bit sore following the operation over the wounds. However most people are able to resume daily activities soon after the surgery. Discuss with the surgeon prior to the operation how much time they would recommend off work. There is a strict follow-up plan after the operation. The plan for review is different for each surgeon and hospital. It is important to attend all appointments made for you after surgery. In a hospital setting, the patient may visit with allied health (such as physiotherapy, dietician) and a surgeon. If you suspect there is a problem after surgery it is a good idea to visit with your general practitioner and call your surgeon to discuss your concerns. A person who follows the eating plan set out by the dietician and exercises regularly, will have the best chance of losing weight. It is important to see your doctor regularly for check-ups. This will allow doctors to monitor how much weight you lose and the speed of weight loss. Some patients will also be monitored with regular blood tests. If you plan to become pregnant after this surgery you should discuss this with your doctor. The most important part of follow-up after the surgery is learning to adjust your diet. After surgery, patients need to eat more slowly. You should eat three standard meals a day and try not to snack between. A dietician will advise people on which specific foods are best. All patients should avoid sugary drinks (e.g. ice-cream shakes, soft drinks) and liquid meals (e.g. protein shakes) as these will pass straight through the pouch created by the stomach band, and will not give a person a sense of "fullness". These drinks are a potential cause of failure to lose weight after surgery. It is possible that the band may need to be adjusted at a later stage to maintain weight loss. Your doctor will advise you of any symptoms to watch out for that may require special treatment. It is also important to tell other doctors you may see about having had this procedure.

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The formula for calculating your body mass index is:
BMI = weight (kilograms) / (height (metres) * height (metres))

For example:
A man who weighs 85 kilograms and is 1.8 metres tall would have a BMI of
BMI = 85 / (1.8 * 1.8)
BMI = 85 / 3.24
BMI = 26.2

This information will be collected for educational purposes, however it will remain anonymous.

Morris, P. Wood, W. (2000) [2nd edition] Oxford textbook of Surgery: Chapter 25; Surgery for Obesity [chapter author Grace, M.] Oxford University Press: Oxford.Allergan Australia (2007) About laparoscopic gastric banding [cited 11th December 2007] Available online [http://www.gastricbandingsurgery.com.au/ about_gastric_banding.php]Kral, J. (2006) ABC of Obesity: Management: Part III - Surgery [5th article in series] British Medical Journal 333; p 900 - 903. Available online [http://www.bmj.com]Snow, V. Barry, P. Fitterman, N. Qaseem, A. Weiss, K. et al (2005) Clinical Guidelines: Pharmacologic and Surgical Management of Obesity in Primary Care: A clinical practice guidelines from the American College of Physicians. Annals of Internal Medicine 142: 7; p 525 - 531.Sjorstom, L. Lindroos, A. Peltonen, M. Torgson, J. Bouchard, C. Carlsson, B. et al (2004) Lifestyle, diabtes and cardiovascular risk factors 10 years after bariatric surgery. New England Journal of Medicine 351; 26: p 2683 - 2693.Sjostrom, C. Lissner, L. Wedel, H. Sjostrom, L. (1999) Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS Intervention Study. Obesity Research 7: p477- 484.Northern Rivers General Practice Network (cited 12th December 2007) What GPs should know about lap banding. Available online [http://www.medicineau.net.au/ clinical/obesity/obesit3160.html]Colquitt, J. Clegg, A. Loveman, E. Royle, P. Sidhu, M. (2005) Surgery for morbid obesity. [Cochrane clinical review] Available online: [http://www.mrw.interscience.wiley.com/ cochrane/clsysrev/articles/CD003641/frame.html]Wilkinson, S. (cited December 21st 2007) Obesity Surgery: Lap-Band Surgery, Am I a suitable candidate? Available online: [http://www.tasmaniaobesitysurgery.com.au/ lapband.html]National Health and Medical Research Council (2003) Clinical Practice Guidelines for the management of overweight and obesity in Australia [update 19th March 2004] Commonwealth of Australia, Department of Health and Ageing [Available online: www.obesityguidelines.gov.au]

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Cardiac MRI (Magnetic Resonance Imaging)

MRI stands for magnetic resonance imaging, a diagnostic technique that uses harmless radio waves rather than x-rays to create images.

Cardiac magnetic resonance imaging (CMR) is currently the most accurate and reproducible technique for imaging the heart. It has outstanding image resolution and intrinsic tissue contrast. CMR is safe, non-invasive, and does not expose patients to ionising radiation. Sometimes a contrast dye is injected into the veins to highlight certain features that would not otherwise be visible. 

MRI is a safe and painless means of looking inside the body without using radiation. Detailed pictures of the body can be produced by using a large magnet, radio waves, and a computer, often providing information that could not be obtained from other investigations (e.g. x-rays or ultrasound).

 

The body is made up of small particles called atoms. Hydrogen atoms, a major component of water, make up 95% of your body. Normally, the hydrogen atoms within your body spin around at random. However, when a patient lies within the bore (the central tunnel) of a large, strong magnet, the same hydrogen atoms naturally line up and all spin in the same direction. When a radio wave is passed through the body, it causes the hydrogen atoms to give off signals. The scanner detects these signals and, with the aid of a computer, they are reconstructed into images of the body.

Until recently, clear pictures of the beating heart could not be obtained due to the heart's constant movement. To overcome this, cardiac MRI uses ECG gating. This allows the scanner to coordinate the pictures with the movement of the heart.

Patients are asked to change into a medical gown. As the magnetic field will damage credit cards, mobile phones and any electronic equipment, these must be left outside the scan room, along with all jewellery and clothing with metal (e.g. zips or jean rivets). The machine will make loud knocking noises while scanning, so patients are often provided with head phones which act as ear protectors and allow them to listen to music during the procedure. The patient lies down on a sliding 'table' and ECG electrodes are attached, before they are moved into the scanner.

The scan can last from 30 minutes to an hour. Patients may be asked to hold their breath for 10-20 seconds during some imaging sequences. The patient should remain motionless in order to produce a clear picture. Throughout the examination, radiographers are able to communicate with the patient via intercom to ensure that the patient is informed and comfortable.

There are several contraindications to MRI. In particular, patients who have implanted medical devices (e.g. pacemakers or defibrillators, cochlear implants, cerebral aneurysm clips), or who may have iron fragments in their eyes, are not suitable for MRI investigation. Orthopaedic pins, mediastinal clips, coronary stents, and the majority of artificial heart valves are safe to scan.

There are no known risks from undergoing MRI during pregnancy. However, as with any medical investigation, a patient who suspects that she is pregnant should seek advice on the risks versus benefits of undergoing the investigation.

Around 4% of patients will suffer from claustrophobia to a degree that will not allow them to tolerate a MRI scan. This can be reduced to < 2% by sedating with oral or IV benzodiazepines.

There is also the risk of patients being injured if they forget to remove pieces of metal from their person or clothing. If sedation is required, there are associated risks of overmedication. If a contrast dye is used, there is a small risk of an allergic reaction, although this risk is very low.

The MRI scan is a painless and safe scan that produces clear images of the body, from any angle. The pictures are clearer than those obtained by most other techniques, including both echo and SPECT scanning. It uses no radiation and therefore eliminates the substantial x-ray doses of cardiac CT scans.

Cardiac MRI is useful in a wide variety of cardiac conditions. It can demonstrate the structure and function of cardiac chambers, and help quantify the flow of blood through the cardiac valves. It is particularly valuable for assessing abnormal heart muscle (cardiomyopathy) and the damage done by previous heart attacks.

While MRI provides a very high standard image, it is time consuming and more expensive than some other investigations. Very obese patients may not be able to fit comfortably within the MRI machine, and patients with severe heart failure may struggle to lie flat for the duration of the test. Some patients will suffer from claustrophobia to a degree that will not allow them to tolerate a MRI scan. In patients with very fast heart rates, or frequent irregular beats, ECG gating can prove unreliable.

Although not yet widely available in many regions of Australia, cardiac MRI is an established technique in many countries for the diagnosis and management of diseases of the cardiovascular system.

The uses of a cardiac MRI include:

Aortic disease

Cardiac MRI accurately displays the size and shape the aorta. The lack of radiation makes cardiac MRI ideal for repeated examinations, such as the evaluation of patients with Marfan's syndrome and aortic dilatation, or serial review of coarctation as is seen in the image on the right. Cardiac MRI can also be used for the quantification and characterisation of cholesterol plaques in the major arteries.

Ischaemic heart disease

There are multiple approaches to detecting coronary artery disease by cardiac MRI. Blood flow can be assessed at rest and under stress to demonstrate significant coronary blockages. Due to the higher resolution, cardiac MRI may be able to detect smaller areas of ischaemia than would be visible by nuclear scanning. This high resolution also allows detection of wall motion abnormalities, which may affect the heart's function.

Cardiac MRI can be used for determining the presence, size and location of a heart attack by the technique of delayed enhancement. Delayed enhancement accurately defines myocardial scar, and provides a reliable method to assess the likelihood of recovery of heart function after bypass surgery. It can also be helpful in deciding the cause of heart failure. Coronary arteries can be visualized by cardiac MRI, and coronary stenoses can be demonstrated. It is also possible to assess the flow within the coronary arteries.

Cardiomyopathy

While echocardiography is still the mainstay of diagnosis in cardiomyopathies, cardiac MRI can be used to demonstrate the abnormalities in heart muscle and function, particularly those associated with cardiomyopathies. In particular, cardiac MRI is useful in the diagnosis and follow-up of arrhythmogenic right ventricular dysplasia.

Cardiac masses

Echocardiography remains the initial diagnostic tool for the assessment of cardiac masses, particularly thrombus or tumour. Unlike an echocardiogram, cardiac MRI can easily differentiate between these two diagnoses. It is also useful in the classification of cardiac tumours.

Valvular heart diseases

Cardiac MRI can now be used to clearly assess valvular heart diseases (e.g. narrowed or leaky heart valves), and any damage they have caused to the heart.

Pericardial disease

The pericardium is a fibrous sack that surrounds the heart. An MRI can show any changes to the structure of this sack, and help decide the difference between diseases of the pericardium and of the heart muscle.

Congenital heart diseases

Cardiac MRI is used to give detailed information about the structure and function of the heart in cases where there have been problems with the heart's development. A cardiac MRI can also be used to give an idea of how and where blood is flowing, which can often be very complicated.

Other

CMR is useful in a wide variety of other cardiac diseases, including left ventricular non-compaction, infiltrative cardiomyopathy and myocarditis. In siderotic cardiomyopathy, caused by iron deposition, myocardial biopsy can be avoided by the use of cardiac MRI.

(Kindly reviewed by Dr JF Younger FRACP MRCP, BHF Cardiac MRI Unit, Department of Academic Cardiology, Leeds General Infirmary, Leeds, West Yorkshire, UK.) Anderson LJ, Holden S, Davis B, et al. Cardiovascular T2* magnetic resonance for the early diagnosis of myocardial iron overload. Eur Heart J. 2001; 22: 2171-9. Bellenger NG, Davies LC, Francis JM, et al. Reduction in sample size for studies of remodelling in heart failure by the use of cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2000; 2: 271-8. Cesare ED, Giordano AV, Cerone G, et al. Comparative evaluation of TEE, conventional MRI and contrast-enhanced 3D breath-hold MRA in the post-operative follow-up of dissecting aneurysms. Int J Card Imaging. 2000; 16: 135-47. Chernoff D, Stark P. Principles of magnetic resonance imaging [online]. UpToDate. [cited 13 July 2006]. Available at URL: http://www.uptodate.com Fayad ZA, Nahar T, Fallon JT, et al. In vivo magnetic resonance evaluation of atherosclerotic plaques in the human thoracic aorta: a comparison with transesophageal echocardiography. Circulation. 2000; 101: 2503-9. Hornak JP. The basics of MRI, 2006 [online]. The Centre for Imaging Science. [cited 12 July 2006]. Available from URL: http://www.cis.rit.edu/ htbooks/ mri/Kanal E, et al. ACR White Paper on Magnetic Resonance Safety: ACR Magnetic Resonance Safe Practice Guidelines. American College of Radiology, 2004. Kim RJ, Wu E, Rafael A, et al. The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med. 2000; 16: 1445-53. Klein C, Nekolla SG, Bengel FM, et al. Assessment of myocardial viability with contrast enhanced magnetic resonance imaging: Comparison with positron emission tomography. Circulation. 2002; 105: 162-7. Magnetic Resonance Imaging: Body [online]. Radiology Info. Radiological Society of North America, 2006 [cited 12 July 2006]. Available at URL: http://www.radiologyinfo.org/ Magnetic Resonance Imaging: Cardiac [online]. Radiology Info. Radiological Society of North America, 2006 [cited 12 July 2006]. Available at URL: http://www.radiologyinfo.org/Mahrholdt H, Goedecke C, Wagner A, et al. Cardiovascular magnetic resonance assessment of human myocarditis: A comparison to histology and molecular pathology. Circulation. 2004; 109: 1250-8. McCrohon JA, Richmond DR, Pennell DJ, et al. Isolated non-compaction of the myocardium: A rarity or missed diagnosis? Circulation. 2002; 106: e22-3. Pennell DJ, Sechtem UP, et al. Clinical indications for cardiovascular magnetic resonance (CMR): Consensus Panel Report. Journal of Cardiovascular Magnetic Resonance. 2004; 6(4): 727-65.Plein S, Greenwood JP, Ridgeway JP, et al. Assessment of non-ST segment elevation acute coronary syndromes with cardiac magnetic resonance imaging. J Am Coll Cardiol. 2004; 44(11): 2173-8. Reimer P, Parizel PM, Stichnoth FA (editors). Clinical MR Imaging: A Practical Approach (2nd Edition). Heidelberg, Springer-Verlag, 2003. Schwitter J, Nanz D, Kneifel S, et al. Assessment of myocardial perfusion in coronary artery disease by magnetic resonance: A comparison with positron emission tomography and coronary angiography. Circulation. 2001; 103: 2230-5.



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Ban trans fats!

Banning the use of trans fats in the preparation of foodstuffs is one of the most effective ways to prevent some of the world's biggest killer diseases, but many governments are not taking such action because they do not think these bans work, according to a University of Sydney study published in the Bulletin of the World Health Organisation.

Shauna Downs, lead author and researcher at the University's Menzies Centre for Health Policy at the University of Sydney, Australia said trans fats policies in Brazil, Canada, Costa Rica, Denmark, the Netherlands, the Republic of Korea and the United States of America (USA) over the last two decades had proven to be effective in removing trans fats from the food supply.

She said the study's findings were particularly relevant for low- and middle-income countries where such measures have been identified as a "best-buy" policy for health - ie one that is expected to provide a high return on investment in terms of health gains.

"We found for example, that a national ban in Denmark virtually eliminated trans fats from the food supply, while local bans in Canada and the USA were successful in removing trans fats from fried foods," Ms Downs said.

"While some of the government policies we studied imposed voluntary self-regulation and others took mandatory measures, such as labelling, local and national bans on trans fats proved to be the most effective policies for removing trans fats.

"Our findings show that these policies are not only feasible and achievable - they are also likely to improve public health."

Trans fats - also known as trans fatty acids - are naturally found in dairy and meat products but also generated by industrial processes to produce hard fats from vegetable oils. The industrially produced trans fats are also known as partially hydrogenated vegetable oils.

Consumption of trans fats is associated with an increased risk of non-communicable diseases, including cardiovascular disease, such as heart disease, as well as stroke and diabetes.

These partially hydrogenated vegetable oils are, however, favoured by the food industry and fast food outlets because they are cheap, have a long shelf life, are semisolid at room temperature, which makes them easier to use in baked products, and can withstand repeated heating.

The World Health Organization (WHO) has called for the elimination of trans fats from the global food supply in response to the rise in the prevalence of non-communicable diseases and has identified it as a "best-buy" public health intervention for low- and middle-income countries. This proposed policy measure was advocated in the Political Declaration of the High-level Meeting of the UN General Assembly on the Prevention and Control of Non-communicable Diseases in September 2011.

Dr Francesco Branca, department director for Nutrition for Health and Development at WHO, said the University study was important because it gave an overview of current policy approaches and compared their effectiveness.

"It provides a rationale for strong regulations, such as national bans, and challenges voluntary approaches, given that their outcomes have been less satisfactory than mandatory measures."

(Source: University of Sydney: World Health Organisation)

Article Date: 16/4/2013

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Slim women have a greater risk of developing endometriosis than obese women

Women with a lean body shape have a greater risk of developing endometriosis than womn who are morbidly obese, according to the largest prospective study to investigate the link.

The study, which is published online today (Wednesday) in Europe's leading reproductive medicine journal Human Reproduction [1], found that the risk of endometriosis was 39% lower in morbidly obese women - those with a body mass index [BMI] greater than 40kg/m2- compared with women with a current BMI in the low normal range (18.5-22.4 kg/m2).

When the researchers looked back at the women’s BMIs when they were 18, they found that women who were morbidly obese at that point in their lives had a 41% lower risk of developing endometriosis than women with low normal BMI.

The association was strongest in the group of women who were infertile – those who had been trying to become pregnant for more than a year: there was a significantly lower rate of endometriosis (62%) among the currently morbidly obese compared with those with a low normal BMI, while it was 77% lower among women who were morbidly obese at age 18 compared with those with a low normal BMI at 18.

The authors of the study stress that although their findings establish firm evidence of a link between endometriosis and BMI, it does not show that low BMI causes endometriosis. “It is important to note that despite the strength of the evidence underlying the association between body weight and endometriosis, inferences regarding causation or the pathophysiologic process underlying these relations cannot be made,” they write in their paper.

The mechanisms that might be responsible for the link between BMI and risk of endometriosis are unclear, but the researchers point to the possibility that BMI at a younger age may have an influence on health in later life, especially as it is known to have an effect on other diseases; and also that polycystic ovarian syndrome (PCOS) is more common among obese women and the effect it has on menstruation and hormones might play a role in reducing or slowing the growth of endometrial lesions.

First author of the study, Clinical Assistant Professor, Divya Shah (MD), at the University of Iowa Hospitals and Clinics (Iowa City, USA), said: “Further research is needed to understand the biological mechanisms underlying the associations that we have seen in our study. Maintaining a healthy body weight (BMI 20-24.9 kg/m2) throughout childhood, adolescence, and adulthood is associated with a myriad of known health benefits. The study does not suggest that the morbidly obese women are, in some way, healthier than the lean women and that is the reason for their lower risk of endometriosis. It is more likely that factors related to infertility, which is more common among the very obese, are linked to the reduced risk of endometriosis.

“Our finding that lean women have a higher risk is useful information for doctors when making a diagnosis. It also means that future research can focus on these women to discover the causes, so that we can design treatments that could help prevent the condition developing.”

The findings come from the Nurses’ Health Study II (NHS II), which has been following 116,430 female nurses in the USA since September 1989. Data were analysed after ten years, but now the researchers have a total of 20 years of data from 1989 to June 2011.

During the 20 years of the study, a total of 5504 women were diagnosed with endometriosis using laparoscopy [2]. Only women with a diagnosis of endometriosis that had been confirmed by laparoscopy were included in the analyses. The women were between 25-42 years of age when they were enrolled in the study in 1989. They completed a questionnaire about their medical history when they joined the study, including their weight and height at the age of 18, and then at two-year intervals thereafter. Information on current weight, height, and, from 1993, waist and hip circumference and any diagnosis of laparoscopically-confirmed endometriosis was also included.

The senior author of the study, Associate Professor, Stacey Missmer (ScD), of Harvard Medical School (Boston, USA), said: “Analysis of the first ten years of NHS II data revealed an inverse relation between endometriosis and BMI at age 18 among all women, and, in a subset of infertile women, an inverse relation between endometriosis and current BMI. Availability of an additional ten years of NHS II data yielded 2986 additional cases of endometriosis, and enabled us to trace women who were diagnosed with endometriosis after age 25 through most of their reproductive lifespan. This study confirms that women with a low BMI, both currently and at age 18, have a greater risk of developing endometriosis. The association remains stronger in infertile women, but is present in all women regardless of fertility status.

“Insomuch as any data can ever claim to be definitive, we do believe that this large prospective study provides conclusive evidence of the inverse association between endometriosis and BMI.”

Endometriosis is estimated to affect approximately one in ten women of reproductive age. As a diagnosis of endometriosis can only be confirmed by laparoscopy, it is difficult, if not impossible, to establish the precise point at which endometriosis appears. A recent study of women in 16 centres in ten countries [3], showed that the average age at which women presented with symptoms of endometriosis was 26, with most women experiencing a delay of six or seven years between the onset of symptoms and a definitive diagnosis.

Source eshre

Article Date: 17/6/2013

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What You Need to Know About The 90/10 Diet

The 90/10 diet can be found in a book written by nutritionist Joy Bauer called The 90/10 Weight-Loss Plan: A Scientifically Designed Balance of Healthy Foods and Fun Foods. The book can be purchased for approximately $18 online or at other book retailers. There are no required foods or expensive recipes necessary to follow this plan. The basic premise of the 90/10 plan is that you eat a healthful diet 90 percent of the time, and enjoy what Bauer calls “fun foods” 10 percent of the time. Bauer’s theory is that by allowing yourself your favorite foods some of the time, you will feel less deprived and more able to stick with the healthy changes the rest of the time. The book outlines diets for three different daily calorie levels -- 1,200, 1,400, and 1,600. There are two weeks worth of meals outlined in this plan. Once you are accustomed to practicing portion control, monitoring your calories, and planning your fun foods, you will also be able to customize your meals to your own preferences as long as you stay within your caloric allowance.

During my trial of the diet, a typical day’s menu was oatmeal with fruit for breakfast, a tuna melt with low-fat cheese for lunch, an apple for snack, chicken and vegetables with brown rice for dinner, and chocolate chip cookies as my fun food.

What I liked about this diet was being able to continue to allow myself a controlled portion of nearly any food as long as I followed the guidelines the rest of the time. I was able to enjoy “old favorites” that other diets forbid. (So many other diets ask you to go "cold turkey" on favorite foods, especially during the first week or so, or during the first “phases” of the plan. I often find those diets too difficult to stick to for any period of time, but did not have that problem with this plan.) The only "catch" to this plan is that you have to work the fun foods into your daily calorie allotment; I was on the 1,600 calorie plan, so those 260 calories from my cookies left me 1,340 calories to utilize for the rest of the day. Since my calorie allotment was on the higher end, I did not often have a problem working in everything I needed to round out my day’s food intake.

However, I can see that this may be challenging to someone on the lower end of the spectrum, at 1,200 calories, especially if you are not accustomed to monitoring your food or calorie intake. For example, let’s say you plan tomorrow morning for a 300 calorie treat as your "fun food" and then you decide to have a soda with it, too. If you only have 750 calories remaining for your entire day after your treat, you have used too many calories and did not allow sufficient calories for other more nutritious, filling choices. That’s why planning is so important so you “spend” your calories the best way possible.

During my 30-day trial of this plan, I lost just under eight pounds. I found this plan to be effective and reasonably easy to follow.

You can easily track your daily calories and search for foods’ caloric content at a free Web site such as Calorie Count Plus. I searched their food database on a daily basis to find out the calorie counts of foods that I did not have a nutrition label for.

In my opinion, the inclusion of “fun foods” makes this diet ideal for people who have found other diets to be too restrictive. I think most people would be able to stick to this plan. If you are allowed 1,600 or 1,800 calories you will undoubtedly have enough calories to eat plenty of the healthy foods recommended on the plan and still have your “fun foods”.

Maintenance may be a little more challenging for some after following this plan; you will need to continue being conscious of your food choices and caloric intake. Once you’re at your goal weight, you will need fewer calories than you were previously accustomed to eating before you lost weight, so it is important that you continue monitoring you caloric intake (You can do so easily by tracking your food intake with Calorie Count Plus.). Remember, if you return to consuming more calories than you need -- after this or any other diet -- you will begin to gain weight again.

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The 3-Day Military Diet (Review)

Do these men eat Skinny Cows?

Walter B. McKenzie/Getty Images

Are you tempted to try the Military Diet? The quick weight loss program, sometimes called the “3 Day Diet,” is popular on Pinterest, Facebook and other social media sites. According the claims, you can lose up to 10 pounds per week or 30 pounds in a month. Sounds attractive, huh? But before you try this eating plan, a word of caution is advised.

This weight loss program is a “3 day on/4 day off” eating plan. According to the website, the diet is a “combination of low calorie, chemically compatible foods designed to work together and jump start your weight loss.” There is no further information about what they mean by “chemically compatible.” There is also no mention of any real affiliation or history with the military.

It is unclear who (or what) is behind the Military Diet, although there is clearly someone collecting revenue from paid advertisements on the site. The language on the site and the “contact” portal would leave you to believe that there is someone available to answer questions or offer advice. But I tried reaching out to them (anonymously) on several occasions and no one ever replied.

I can’t promise that you will lose weight on any diet, but if you follow The Military Diet you will probably lose a few pounds. I doubt that you’ll lose ten in the first week. So do I recommend the Military Diet? No. In fact, I would predict that if you try the diet, you will regain the weight – and maybe put on more weight in the months after dieting.

Why will the weight come back? First, because the food plan is not sustainable for most people. Very few dieters would be able to spend their lives eating grapefruit and saltines for all of eternity. And second, because some foods that you’ll get used to on the diet are very high calorie, high fat foods. For example, on day two of the diet you eat hot dogs and ice cream for dinner. If you get used to eating foods like that, you’re likely to eventually make portion size mistakes and gain weight as a result.

Much of the information about diet's website just doesn’t make sense. Because the Military Diet doesn’t actually sell anything, their claims don’t have to be backed up by any real data. Here are a few examples of the claims that don’t add up:

There are no days off. You get the idea that you this is a 3 day on/4 day off plan – which would imply that you eat a normal diet for four days during the week. But this plan actually requires you to diet all the time. Here’s what the site says about your four days “off”

“On the four days off, we recommend a diet of about 1300 – 1500 calories per day, made of up lean protein, veggies and easy on the carbs.”

I had to laugh out loud when I read this statement. Because anyone who eats a calorie controlled diet that includes the right amount of lean protein, the correct ratio of carbs and plenty of veggies doesn’t need a diet in the first place.
Calorie counting in disguise. The Military Diet is no different than any other plan that requires you to understand and record your caloric intake. If you substitute any food on your three days “on” you are required to measure your food and add up calories. On your four days “off” you are also required to count calories.
Natural diet claims are questionable. The diet claims to be “one of the best natural diets.” They recommend that dieters avoid artificial sweeteners because they “aren’t good for you.” But then the site goes on to include foods like hot dogs and Skinny Cow brand treats in the daily meal plans. I’ve got nothing against hot dogs or Skinny Cows, but they are both loaded with artificial ingredients that aren’t natural.
What about water weight? The site claims that when a dieter loses weight on the diet, it “is not just water weight.” But there is no further documentation provided. I’m not sure why a dieter would believe that claim without significant evidence to prove otherwise.

If you need to lose weight quickly, any diet that requires you to significantly decrease your caloric intake will cause weight loss. In most cases, the weight loss is not sustainable and in many cases, the dieter regains more than they lost. I don’t recommend quick weight loss programs, but if I had to, I would recommend one that includes healthier foods than hot dogs.

For long-term weight loss, I wouldn’t recommend this plan either. Your health is too important to trust it to a nameless, faceless fad on the internet. Find the right diet for you and invest a little time and effort into putting a reasonable healthy plan in place. Is it more work in the beginning? Yep! But you're far more likely to achieve sustainable results.

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Weight Loss Pills and Supplements

The use of weight loss supplements is tempting. Who wouldn't want a little help to make the struggle easier? But there are hundreds of diet pills on the market. It can be confusing to sort through the claims and find a weight-loss product that is safe and effective.

There are two categories of weight loss aids: prescription medications and non-prescription or over-the-counter (OTC) products. As a general rule, the use of OTC weight-loss products is discouraged. In a study published by the Journal of the American Dietetic Association researchers made a clear statement about their use. "Dietary supplements are not recommended as part of a weight-loss program due to concerns about efficacy and safety."

The American Dietetic Association (ADA) also addresses the use of prescription diet pills. In a policy statement, they acknowledge that weight-loss medications may help dieters lose a modest amount of weight initially, but the long-term safety and effectiveness of these types of medications have not been established.

The best resource for information regarding the use of any supplement is your healthcare provider. Ask your doctor about current research into the products that have aroused your interest. Your doctor will also be able to discuss how taking one of the aids might interact with your other medications and will also be able to provide the best advice regarding the safety of new products.

Phentermine. Phentermine is marketed under a long list of names, including Suprenza, Adipex-P, Kraftobese and Teramine. It is prescribed only for short periods and works by decreasing a dieter's appetite. According to the ADA, it is the most widely prescribed weight-loss supplement in the United States. However, the drug can be habit forming; side effects can include insomnia, constipation and dry mouth.Xenical (orlistat). This prescription medication has been approved by the U.S. Food and Drug Administration (FDA) since 1999. Xenical is a lipase inhibitor, which means it works by blocking the absorption of fat. While that might seem to be the perfect weight-loss solution, there can be significant side effects, and the drug is meant to be combined with a low-fat, low-calorie diet.Meridia (sibutramine). This appetite suppressant product was removed from the market in the United States in 2010. The FDA initially approved the product, but the manufacturer stopped producing it after clinical studies showed that users had an increased risk of heart attack and stroke. The National Institutes of Health (NIH) recommends that anyone still using Meridia contact their physician to discuss alternative treatments.Alli (orlistat). This product has gained attention because it is a lower dose version of the drug orlistat, which is found in prescription Xenical. Alli is the OTC weight-loss product approved by the FDA. It works by blocking the body's absorption of fat. However, Alli is not a cure-all for obesity. For Alli to work properly, dieters still need to limit fat intake and make lifestyle changes. If you try to take the pill without making changes, side effects can be uncomfortable or even intolerable. Eating just one high fat meal may result in an inability to control bowel movements; loose or liquid stool; or oily discharge.Ephedra, ephedra-free products and bitter orange. When ephedra was banned from the market in 2004, a number of similar stimulants took its place. Most advertise they are ephedra-free and safe for dieters. They often contain bitter orange (citrus aurantium), synephrine or octopamine. Two of the most popular products, Xenadrine EFX and Advantra Z, were tested by researchers and still found to have unsafe effects on heart rate and blood pressure.Chromium. Sometimes marketed as chromium picolinate, products that contain this substance often claim to help you burn extra calories and decrease your appetite. However, the NIH found that chromium has no significant benefits for weight loss. Chromium is generally considered to be safe, but it is likely to drain your wallet without any significant benefit to your waistline.Green tea. Green tea can be consumed as a beverage or in pill form. It is often used to aid in weight loss or for improving mental alertness or lowering blood pressure. While green tea is safe when consumed in moderation, there is little evidence to support its use as a weight-loss supplement.Hoodia. This herb is sold as a hunger suppressant for dieters. Hoodia is extracted from a flowering plant and can be consumed in tablet, pill or powder form. There is no scientific evidence to support the claims that hoodia is an effective appetite suppressant, and its safety has not been verified.

Sources:

Chromium. Office of Dietary Supplements, National Institutes of Health. Accessed: November 28, 2011. http://ods.od.nih.gov/factsheets/chromium

Heidi Michels Blanck PhD, Mary K. Serdula MD, Cathleen Gillespie MS, Deborah A. Galuska PhD, Patricia A. Sharpe PhD, MPH, Joan M. Conway PhD, RD, Laura Kettel Khan PhD, Barbara E. Ainsworth PhD. "Use of Nonprescription Dietary Supplements for Weight Loss Is Common among Americans." Journal of the American Dietetic Association March 2007, Pages 441-447 .

EatRight.org Weight Management. American Dietetic Association. Accessed: December 15, 2011. http://www.eatright.org/About/Content.aspx?id=8382

Sharpe PA, Granner ML, Conway JM, Ainsworth BE, Dobre M. "Availability of weight-loss supplements: Results of an audit of retail outlets in a southeastern city." Journal of the American Dietetic Association. 2006 Dec;106(12):2045-51.

Haller CA, Benowitz NL, Jacob P 3rd. "Hemodynamic effects of ephedra-free weight-loss supplements in humans." The American Journal of Medicine 2005 Sep;118(9):998-1003.

Weight Control Information Network. "Choosing a Safe and Successful Weight Loss Program". U.S. Department of Health and Human Services, National Institutes of Health. Accessed: November 28, 2011. http://win.niddk.nih.gov/publications/choosing.htm

"Weighing the Evidence in Diet Ads". Federal Trade Commission. Accessed: November 28, 2011. Government PDF

"Dietary Supplements For Weight Loss. Limited Federal Oversight Has Focused More on Marketing than on Safety." Janet Heinrich?Director, Health Care-Public Health Issues. Accessed: November 25, 2011. Government PDF

Amelia Hollywood and Jane Ogden. " Taking Orlistat: Predicting Weight Loss over 6 Months." Journal of Obesity October 2010 .

Green Tea. National Institutes of Health, National Center for Complimentary and Alternative Medicine.. Accessed: November 28, 2011. http://nccam.nih.gov/health/greentea/index.htm

Hoodia. National Institutes of Health, National Center for Complimentary and Alternative Medicine. Accessed: November 25, 2011. http://nccam.nih.gov/health/hoodia/

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Weight Loss Surgery - A Rising Trend

Are you tired of constantly combating with the heavy bulge? Are you fed up with the repeated attempts of dieting and exercising? Most experts agree that a balanced diet along with regular exercise is the optimum way of losing weight, but the customary path to weight loss doesn't work for everyone.

With obesity on its peak, many countries are evolving as growing hubs of the billion dollar global market for weight loss surgery. A large number of weight loss operations are carried out in popularity in the urban centers all across the world. Today, people are getting more and more conscious about the way they look and how the present themselves to the world. Moreover, the people who are obese do not have just the extra kilos that they need to shed out. They are usually suffering from other weight related co-morbidities too.

Smoking greatly increases the risks from surgery by astringent blood vessels and reducing blood flow. Most surgeons will carry out surgeries on people who have been non-smokers for at least a few months before the surgery. A history of drug or alcohol abuse can also increase the risk for complications and surgery failure. Obesity surgery can be performed on adults between the ages of 18 to 65 although it's becoming more common among adolescents to consider a bariatric surgery.

Undergoing an obesity surgery is an emerging trend among youngsters nowadays. They look at it as a shortcut for losing weight. Moreover, people don't mind paying up, hoping that they will look slim and trim after the surgery. However, a surgery should be considered as an option only if non surgical and natural dieting methods fail.

An increasing number of high profile politicians, Bollywood actors and actresses and even business tycoons are opting for this procedure as they can afford it. Patients usually lose approximately 36% to 90% of their excess body fat in six months to two years of undergoing such surgeries. Bariatric surgery has proven a reduction in the rate of mortality from 40 percent to 23 percent.

In medical language, obesity is considered as a 'killer lifestyle' disease. According to the World Health Organization, approximately 1.2 billion people worldwide are recorded as overweight.

It is important to consult a bariatric surgeon before being a part of this growing fad. It is not just about looking good. There are a number of post surgical restrictions to be considered. If you are unable to follow them properly then it may to lead to weight regain and other complications.

Undergoing a weight loss surgery is a growing fad amongst youngsters today. The article above highlights the importance of consulting a good bariatric surgeon before making this decision.

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