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Tag: anemia

  • Bariatric Surgery: Risks in the OR and Beyond | NutritionFacts.org

    The extent of risk from bariatric weight-loss surgery may depend on the skill of the surgeon.

    After sleeve gastrectomy and Roux-en-Y gastric bypass, the third most common bariatric procedure is a revision to fix a previous bariatric procedure, as you can see below and at 0:16 in my video The Complications of Bariatric Weight-Loss Surgery.

    Up to 25% of bariatric patients have to go back into the operating room for problems caused by their first bariatric surgery. Reoperations are even riskier, with up to 10 times the mortality rate, and there is “no guarantee of success.” Complications include leaks, fistulas, ulcers, strictures, erosions, obstructions, and severe acid reflux.

    The extent of risk may depend on the skill of the surgeon. In a study published in The New England Journal of Medicine, bariatric surgeons voluntarily submitted videos of themselves performing surgery to a panel of their peers for evaluation. Technical proficiency varied widely and was related to the rates of complications, hospital readmissions, reoperations, and death. Patients operated on by less competent surgeons suffered nearly three times the complications and five times the rate of death.

    “As with musicians or athletes, some surgeons may simply be more talented than others”—but practice may help make them perfect. Gastric bypass is such a complicated procedure that the learning curve may require 500 cases for a surgeon to master the procedure. Risk for complications appears to plateau after about 500 cases, with the lowest risk found among surgeons who had performed more than 600 bypasses. The odds of not making it out alive may be double under the knife of those who had performed less than 75 compared to more than 450, as seen below and at 1:47 in my video.

    So, if you do choose to undergo the operation, I’d recommend asking your surgeon how many procedures they’ve done, as well as choosing an accredited bariatric “Center of Excellence,” where surgical mortality appears to be two to three times lower than non-accredited institutions.

    It’s not always the surgeon’s fault, though. In a report entitled “The Dangers of Broccoli,” a surgeon described a case in which a woman went to an all-you-can-eat buffet three months after a gastric bypass operation. She chose really healthy foods—good for her!—but evidently forgot to chew. Her staples ruptured, and she ended up in the emergency room, then the operating room. They opened her up and found “full chunks of broccoli, whole lima beans, and other green leafy vegetables” inside her abdominal cavity. A cautionary tale to be sure, but perhaps one that’s less about chewing food better after surgery than about chewing better foods before surgery—to keep all your internal organs intact in the first place.

    Even if the surgical procedure goes perfectly, lifelong nutritional replacement and monitoring are required to avoid vitamin and mineral deficits. We’re talking about more than anemia, osteoporosis, or hair loss. Such deficits can cause full-blown cases of life-threatening deficiencies, such as beriberi, pellagra, kwashiorkor, and nerve damage that can manifest as vision loss years or even decades after surgery in the case of copper deficiency. Tragically, in reported cases of severe deficiency of a B vitamin called thiamine, nearly one in three patients progressed to permanent brain damage before the condition was caught.

    The malabsorption of nutrients is intentional for procedures like gastric bypass. By cutting out segments of the intestines, you can successfully impair the absorption of calories—at the expense of impairing the absorption of necessary nutrition. Even people who just undergo restrictive procedures like stomach stapling can be at risk for life-threatening nutrient deficiencies because of persistent vomiting. Vomiting is reported by up to 60% of patients after bariatric surgery due to “inappropriate eating behaviors.” (In other words, trying to eat normally.) The vomiting helps with weight loss, similar to the way a drug for alcoholics called Antabuse can be used to make them so violently ill after a drink that they eventually learn their lesson.

    “Dumping syndrome” can work the same way. A large percentage of gastric bypass patients can suffer from abdominal pain, diarrhea, nausea, bloating, fatigue, or palpitations after eating calorie-rich foods, as they bypass your stomach and dump straight into your intestines. As surgeons describe it, this is a feature, not a bug: “Dumping syndrome is an expected and desired part of the behavior modification caused by gastric bypass surgery; it can deter patients from consuming energy-dense food.

    Doctor’s Note

    This is the second in a four-part series on bariatric surgery. If you missed the first one, see The Mortality Rate of Bariatric Weight-Loss Surgery.

    Up next: Bariatric Surgery vs. Diet to Reverse Diabetes and How Sustainable Is the Weight Loss After Bariatric Surgery?.

    My book How Not to Diet is focused exclusively on sustainable weight loss. Check it out from your local library, or pick it up from wherever you get your books. (All proceeds from my books are donated to charity.)

    Michael Greger M.D. FACLM

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  • Are Your Dog’s Gums Pale? It’s a Health Warning | Animal Wellness Magazine

    Your dog’s gums should appear a healthy salmon pink. Pale gums in dogs signal potential health issues. Regular checks can identify problems early. Familiarize yourself with your dog’s normal gum color. This simple habit empowers you to act swiftly if something seems off. If your furry companion resists, don’t force the issue. Instead, consult a veterinarian for guidance.

    Checking for Hydration and Circulation

    Assess hydration by feeling the gums. They should feel moist and slightly damp. Dry or sticky gums indicate dehydration, a serious concern. Next, test circulation using the capillary refill method. Press gently on the gums until they turn white. Release your finger. The color should return to pink within two seconds. If not, poor circulation could be at play.

    When to Seek Help

    Pale gums can indicate severe issues such as anemia or shock. If your dog’s gums appear any color other than salmon pink, contact a veterinarian immediately. Taking a well-lit photo can help when discussing concerns. Quick action often leads to better outcomes, so don’t hesitate.

    Preventive Measures

    Preventive care plays a vital role in maintaining gum health. Ensure regular dental check-ups to avoid gum disease. Incorporate dental treats and toys into your dog’s routine to promote oral hygiene. A balanced diet rich in nutrients supports overall health. Keep your furry companion hydrated and encourage water intake to maintain moisture levels in the gums.

    Treatments and Management Strategies

    Treatment for pale gums in dogs depends on the underlying cause. Blood tests can identify anemia or organ dysfunction. If dehydration is present, your veterinarian may recommend fluids. Anti-inflammatory medications may relieve symptoms of pain or shock. Always follow your vet’s recommendations for a tailored treatment plan.

    Vigilance is key in monitoring gum health. Share this information with fellow dog lovers to spread awareness. Engage in discussions about health and wellness. Together, proactive care can make a significant difference in the lives of our beloved companions.

    Animal Wellness

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  • Cannabis on Fertility and Pregnancy | NutritionFacts.org

    Cannabis on Fertility and Pregnancy | NutritionFacts.org

    Pregnant and breastfeeding women should probably be advised to either decrease or, when possible, cease cannabis use entirely, and couples trying to conceive may also want to consider cutting down. 

    Approximately one in six couples “are unable to conceive after a year and are labeled infertile, with a male factor identified in up to half of all cases.” Several lifestyle factors have been associated with diminished sperm production, such as smoking cigarettes, but what about smoking cannabis? 

    “Regular marijuana smoking more than once per week was associated with a 28%…lower sperm concentration,” as well as a lower total sperm count based on a study of more than a thousand men, but “no adverse association was found for irregular use” of less than once a week.  

    As I discuss in my video The Effects of Marijuana on Fertility and Pregnancy, this wasn’t a randomized study, so other factors that go along with regular marijuana use may have been to blame. Researchers did take into account cigarettes, alcohol, other drugs, STDs, and things like that, but there’s always a possibility there was something else for which they didn’t control. 

    Findings were similar for women. Hundreds of infertile couples were studied in California, and, just as men had about a quarter fewer sperm, a quarter fewer eggs were retrieved from women who used cannabis more than 90 times in their lifetime or had been using the year before. Again, there could have been confounding factors, but until we know more, couples who are trying to conceive may want to make the joint decision to turn over a new leaf.  

    What about during pregnancy? As you can see below and at 1:39 in my video, medical authorities recommend that “women who are pregnant or contemplating pregnancy should be encouraged to discontinue marijuana use” and not use it during pregnancy or lactation, though the Academy of Breastfeeding Medicine suggests the known benefits of breastmilk currently outweigh any potential harms for women who continue to smoke it. Despite these warnings from authorities, marijuana use has increased among pregnant women in recent years, going up by more than 60 percent, but that’s only from about 2.5 percent up to less than 4 percent, which is less than half the frequency of nonpregnant women. 

    Why are OB/GYNs so down on getting high? Scary articles appear in the American Journal of Obstetrics and Gynecology, like one making claims that a “large study conducted by the US National Birth Defects Prevention Center documented a significantly increased risk for anencephaly [a serious birth defect] when the fetus is exposed to marijuana during the first month of gestation.” But, if you don’t just take their word for it and pull up the actual study, you’ll see that the association wasn’t statistically significant after all. As one letter to the editor was titled, “Marijuana and Pregnancy: Objective Education Is Good, but Biased Education Is Not.”  

    Some risks have been identified: Infants “were more likely to be anemic, and…have lower birth weight and to require placement in neonatal intensive care than infants of mothers who did not use marijuana.” However, it’s “difficult to determine the direct effects of maternal cannabis use on the developing fetus” because of a variety of confounding factors for which studies may not be able to completely control. 

    Studies also show links between prenatal marijuana exposure and learning problems later in life—manifesting years later in school—and that’s where the greater concern lies, on the potential long-term effects on brain development. So, even after “weeding out the myths,” there is enough concern that “pregnant and breastfeeding cannabis users should be identified early and advised to either decrease or where possible cease cannabis use entirely.” 

    When do I mean by cut down “when possible?” Check out my video Natural Treatments for Morning Sickness to see how marijuana use during pregnancy can sometimes be a lifesaver. 

    I originally released several videos on cannabis in a webinar and downloadable digital DVD. If you missed any of them, they are listed in the related videos below.  

    For more on fertility, check out Male Fertility and Diet and Dairy Estrogen and Male Fertility. 

    Michael Greger M.D. FACLM

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  • Iron: What You Need to Know

    Iron: What You Need to Know

    Have you felt exhausted lately? Can you barely make it up the stairs without getting winded even though you’re physically fit? If so, you might be lacking in iron — especially if you’re a woman.

    Although many people don’t think of iron as being a nutrient, you might be surprised to learn that low iron is the most common nutritional deficiency in the U.S. Almost 10% of women are iron deficient, according to figures from the Centers for Disease Control and Prevention.

    Let’s look at why iron is so important to your body, what can happen if you’re not getting enough of it, and when you need to take an iron supplement.

    Why Do You Need Iron?

    Iron is an essential mineral. “The major reason we need it is that it helps to transport oxygen throughout the body,” says Paul Thomas, EdD, RD, a scientific consultant to the National Institutes of Health, Office of Dietary Supplements.

    Iron is an important component of hemoglobin, the substance in red blood cells that carries oxygen from your lungs to transport it throughout your body. Hemoglobin represents about two-thirds of the body’s iron. If you don’t have enough iron, your body can’t make enough healthy oxygen-carrying red blood cells. A lack of red blood cells is called iron deficiency anemia.

    Without healthy red blood cells, your body can’t get enough oxygen. “If you’re not getting sufficient oxygen in the body, you’re going to become fatigued,” Thomas says. That exhaustion can affect everything from your brain function to your immune system’s ability to fight off infections. If you’re pregnant, severe iron deficiency may increase your baby’s risk of being born too early, or smaller than normal.

    Iron has other important functions, too. “Iron is also necessary to maintain healthy cells, skin, hair, and nails,” says Elaine Chottiner, MD, clinical assistant professor and director of General Hematology Clinics at the University of Michigan Medical Center said in an email interview.

    How Much Iron Do You Need?

    How much iron you need each day depends on your age, gender, and overall health.

    Infants and toddlers need more iron than adults, in general, because their bodies are growing so quickly. In childhood, boys and girls need the same amount of iron — 10 milligrams daily from ages 4 to 8, and 8 mg daily from ages 9 to 13.

    Starting at adolescence, a woman’s daily iron needs increase. Women need more iron because they lose blood each month during their period. That’s why women from ages 19 to 50 need to get 18 mg of iron each day, while men the same age can get away with just 8 mg.

    After menopause, a woman’s iron needs drop as their menstrual cycle ends. After a woman begins menopause, both men and women need the same amount of iron — 8 mg each day.

    You might need more iron, either from dietary sources or from an iron supplement, if you:

    • Are pregnant or breastfeeding
    • Have kidney failure (especially if you are undergoing dialysis, which can remove iron from the body)
    • Have an ulcer, which can cause blood loss
    • Have a gastrointestinal disorder that prevents your body from absorbing iron normally (such as celiac disease, Crohn’s disease, or ulcerative colitis)
    • Take too many antacids, which can prevent your body from absorbing iron
    • Have had weight loss (bariatric) surgery
    • Work out a lot (intense exercise can destroy red blood cells)

    If you are a vegetarian or vegan, you may also need to take an iron supplement, because the body doesn’t absorb the type of iron found in plants as well as it absorbs the iron from meat.

    How Do You Know If You’re Iron Deficient?

    “People often don’t know they have anemia until they have signs or symptoms — they appear pale or ‘sallow,’ are fatigued, or have difficulty exercising,” Chottiner says.

    If you’re low in iron, you may also:

    • Feel short of breath
    • Have a fast heartbeat
    • Have cold hands and feet
    • Crave strange substances such as dirt or clay
    • Have brittle and spoon shaped nails or hair loss
    • Sores at the corner of the mouth
    • A sore tongue
    • Severe iron deficiency can cause difficulty in swallowing

    If you’re tired and dragging, see your doctor. “It’s fairly easy to detect and diagnose the different stages of iron deficiency with a simple blood test,” Thomas says. Women who are pregnant and people with a gastrointestinal disorder such as Crohn’s, ulcerative colitis, or celiac disease should have their iron tested on a regular basis.

    Do You Need to Take an Iron Supplement?

    If your iron is low, eating a diet that is high in iron-rich foods such as fortified cereals, red meat, dried fruit, and beans may not be enough to give you what you need. Your doctor might recommend that you take an iron supplement.

    Prenatal vitamins usually include iron, but not all prenatal vitamins contain the recommended amount. Check with your doctor before taking any supplement.

    While you are taking iron supplements, your doctor should test your blood to see if your iron levels have improved.

    Can Iron Supplements Cause Side Effects?

    Iron supplements can cause side effects, usually stomach upset such as nausea, vomiting, diarrhea, dark stools, or constipation. Pregnant women are especially susceptible to constipation. Adding extra fiber to your diet can help relieve this symptom. A stool softener may also make you feel better.

    Starting with a low dose of iron and then gradually increasing the dose to the daily recommended amount may help minimize side effects. If your iron supplements are bothering your stomach, your doctor can adjust the dose or form of iron you use. You can also try taking the supplements with food.

    Can You Take Too Much Iron?

    Unlike some supplements, when the subject is iron, more is definitely not better. Adults shouldn’t take any more than 45 mg of iron a day unless they are being treated with iron under close medical supervision.

    For children, iron overdose can be especially toxic. “Iron supplements have killed young children because their needs for iron compared to an adult’s are relatively low,” Thomas says. If you take iron supplements, it is very important to keep them in a high, locked cabinet, far out of your children’s reach. Symptoms of iron poisoning include severe vomiting, diarrhea, abdominal pain, dehydration, and bloody stool in children.

    It’s difficult for adults to overdose on iron just from food and supplements, because an adult body has systems in place to regulate the amount of iron it absorbs. However, people with the inherited condition hemochromatosis have trouble regulating their iron absorption.

    Although most people only absorb about 10% of the iron they consume, people with hemochromatosis absorb up to 30%. As a result, the iron in their body can build up to dangerous levels. That excess iron can deposit in organs such as the liver, heart, and pancreas, which can lead to conditions like cirrhosis, heart failure, and diabetes. For that reason, people with hemochromatosis should not take iron supplements.

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