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Bariatric Surgery: Differences Between a Surgery Center and a Hospital

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When considering bariatric surgery as a solution for weight loss and improved health, one crucial decision patients face is where to undergo the procedure. In Idaho, individuals exploring this option may find themselves debating between a surgery center and a hospital. Both offer unique benefits and considerations, and understanding the differences can help patients make informed decisions about their healthcare journey.

Understanding Bariatric Surgery

Bariatric surgery, also known as weight loss surgery, is a procedure that alters the digestive system to help individuals lose weight by restricting food intake or interrupting the digestive process. It’s often recommended for those with severe obesity or obesity-related health issues like type 2 diabetes and high blood pressure.

The Hospital Setting

Hospitals are traditional settings for surgical procedures, including bariatric surgery. Here are some key points to consider when opting for bariatric surgery at a hospital:

   – Comprehensive Care: Hospitals typically offer a wide range of medical services and specialists, providing comprehensive care before, during, and after surgery.

   – Advanced Facilities: Hospitals are equipped with advanced medical technology and facilities, ensuring access to emergency care and specialized equipment if complications arise.

   – Multidisciplinary Team: Bariatric surgery in a hospital often involves a multidisciplinary team of healthcare professionals, including surgeons, nurses, dietitians, and psychologists, providing comprehensive support.

   – Higher Cost: Bariatric surgery performed in a hospital setting may come with a higher cost compared to surgery centers due to the overhead expenses associated with running a hospital.

The Surgery Center Experience

Surgery centers, like Everest Surgical Institute, also known as ambulatory surgery centers (ASCs), specialize in outpatient procedures and offer an alternative setting for bariatric surgery. Here’s what to expect when choosing a surgery center:

   – Convenience: Surgery centers typically offer a more streamlined experience with shorter wait times, convenient scheduling, and a focus on efficiency, making them appealing to patients seeking convenience.

   – Lower Cost: Bariatric surgery performed at a surgery center may be more cost-effective compared to hospitals, as surgery centers have lower overhead expenses.

   – Specialized Care: While surgery centers may not offer the same range of medical services as hospitals, they often specialize in specific procedures like bariatric surgery, providing focused expertise and personalized care.

   – Reduced Infection Risk: Surgery centers often have lower infection rates compared to hospitals, as they typically handle fewer high-risk cases and adhere to strict infection control protocols.

Considerations for Choosing

When deciding between a surgery center and a hospital for bariatric surgery, it’s essential to consider the following factors:

 – Medical History and Risk Factors: Patients with complex medical histories or higher risk factors may benefit from the comprehensive care and advanced facilities available in a hospital setting.

   – Insurance Requirements: Some insurances may dictate where your procedure will be performed based on certain requirements. With insurance coverage for bariatric surgery becoming more complex, some patients may prefer the self-pay route so they can choose the surgery center option instead of the hospital. To learn more about our self-pay option, visit our Quickstart page.

   – Personal Preferences: Individual preferences regarding convenience, cost, and the overall surgical experience play a significant role in the decision-making process.

   – Surgeon’s Recommendation: Consulting with a specialized clinic and bariatric surgeon at Idaho BMI can provide valuable insights and recommendations tailored to the patient’s specific needs and circumstances.

Choosing between a surgery center and a hospital for bariatric surgery in Idaho involves weighing various factors, including medical needs, insurance requirements, patient preferences, and recommendations from healthcare professionals. Both settings offer unique advantages, and the decision ultimately depends on what aligns best with the patient’s goals and priorities. By carefully evaluating these factors, individuals can embark on their bariatric surgery journey with confidence, knowing they’ve made an informed choice that suits their needs.

Take the first step and Inquire Now with Idaho BMI.

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What is the 3-Incision Gastric Sleeve at Idaho BMI?

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In the realm of bariatric surgery, the quest for effective weight loss solutions has led to the evolution of various techniques, each aimed at addressing obesity and its associated health risks. Among these procedures, the gastric sleeve operation stands out as a popular choice for individuals seeking substantial and sustainable weight loss. One variation of this surgery gaining attention is the 3-incision gastric sleeve at Idaho BMI, performed by Dr. David Brown. In this comprehensive guide, we’ll delve into what exactly this procedure entails, its benefits, potential risks, and who might benefit most from it.

What is a 3-Incision Gastric Sleeve?

The traditional gastric sleeve surgery, also known as sleeve gastrectomy, involves the removal of a large portion of the stomach, leaving behind a sleeve-shaped pouch. This operation involves stapling across the stomach wall and causes significant neurological and hormonal changes, leading to weight loss. The procedure typically requires 5-6 incisions in the abdomen for the insertion of surgical instruments and a camera for visualization.

At Idaho BMI, our approach to the vertical sleeve gastrectomy, is the 3-incision gastric sleeve, which is a modification of this procedure where Dr. Brown utilizes only three small incisions instead of the traditional five or six. These smaller incisions are made strategically to minimize scarring and reduce postoperative discomfort. The difference with the 3-incision gastric sleeve at Idaho BMI is the number of skin incisions required to perform the procedure. It is the least invasive method available for performing the sleeve gastrectomy. It typically takes 30-40 minutes for Dr. Brown to perform a 3-incision sleeve, and is performed with tri-staple technology to reduce the risks of leaks.

How Does the Procedure Work?

During a 3-incision gastric sleeve surgery, Dr. Brown employs a laparoscopic technique, which involves making small incisions in the abdominal wall and using specialized instruments and a camera (laparoscope) to perform the operation, along with a 40 French Bougie to section off the stomach. Dr. Brown removes a large portion of the stomach, leaving behind a narrow tube or sleeve.

By stapling across the stomach during a sleeve gastrectomy, branches of the vagus nerve are divided, causing profound and rapid changes in communication between the stomach and the brain. This “reset” in the communication between stomach and brain results in many overnight alterations noticed by patients including change in smell, taste, appetite, and of course- how much a person can drink or eat. 

The most dramatic change caused by the sleeve gastrectomy is the change in sensory communication between the brain and stomach.  These changes in communication between brain and stomach create a window of time in which the brain is easily reprogrammed, which is generally around 6 months. This period of time is crucial for forming the new habits and lifestyle that will provide a person with long-term success.  Knowing and following the appropriate daily tasks during this “honeymoon period” after surgery is critical to avoid weight regain. This list of tasks is taught clearly and consistently at Idaho BMI.

Benefits of the 3-Incision Gastric Sleeve

Minimized Scarring: With only three small incisions, the procedure results in less noticeable scarring compared to traditional gastric sleeve surgery, which can enhance the aesthetic outcome.

Optimized Pre- and Post-Op Care: Medications are specially formulated for recovery, and include post-op IV Fluids. 

Reduced Pain and Discomfort: Smaller incisions typically translate to less postoperative pain and a quicker recovery time for patients.

Shorter Hospital Stay or Surgery Center stay: Patients undergoing the 3-incision gastric sleeve may experience shorter hospital or surgery center stays compared to those undergoing traditional open surgery, leading to a faster return to normal activities.

Lower Risk of Infection: Fewer incisions means few sites for the skin to become infected.

Potential Risks and Considerations

While the 3-incision gastric sleeve offers several advantages, it’s essential to consider potential risks and limitations associated with the procedure:

Surgical Risks: As with any surgery, there are risks of complications such as bleeding, infection, blood clots, and adverse reactions to anesthesia.

Long-Term Effectiveness: While many patients experience significant weight loss following the procedure, maintaining long-term results requires commitment to lifestyle changes, including dietary modifications, stress management, optimized sleep, and regular exercise as outlined with the Idaho BMI program.

Patient Selection: Not all individuals may be suitable candidates for the 3-incision gastric sleeve. Factors such as BMI, overall health, previous abdominal surgeries, hernia repair, or tissue access are considered when determining eligibility.

Is the 3-Incision Gastric Sleeve Right for You?

Deciding to undergo bariatric surgery is a significant decision that should be made in consultation with a qualified healthcare provider. While the 3-incision gastric sleeve offers several benefits, it’s essential to weigh the potential risks and benefits based on individual circumstances.

Ideal candidates for the procedure typically include individuals with a BMI (Body Mass Index) of 35 or higher, or those with a BMI of 30 or higher with obesity-related health conditions such as type 2 diabetes, hypertension, or sleep apnea.

Idaho BMI, Dr. David Brown, and Everest Surgical Institute are dedicated to providing the highest quality care in bariatric surgery in Idaho. The first step in determining if you are a candidate for bariatric surgery or our Quickstart program, is to Inquire Now. 

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Tapping Into Reserves: Why the Most Important Meal of the Day is the One You Skip

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Episode 23 of Brain Over Belly marks a new chapter of the show. Dr. Brown is happy to welcome his new co-host Hannah, as together they will dive even deeper into the puzzle of obesity and longevity, from the very clinics they work in – Idaho BMI and Everest Surgical Institute.

Metabolism

It’s common for our metabolic rate to decrease as we age, and just as common for Dr. Brown to be asked by a patient how to increase it.

First off, it’s important to know that many studies around metabolism define it as the rate at which a person burns energy. But a different angle might be more accurate and in turn, helpful.

The traditional idea is that food is fuel. That food fuel is needed to exercise, think, work – everything we humans love and need to do. There’s one problem with that idea.

It doesn’t reflect how the body is designed. All of us have stored energy in the form of fat, and the body works better when it burns what’s stored, not what it is fed. And it’s after that burning of stored energy, that we’re really meant to eat. 
We’ve all heard at some point in our lives that breakfast is the most important meal of the day. It’s endorsed by nutritionists, schools, and trainers, and it’s just false. It’s not a stretch to say the most important meal is the one you skip, to allow your body to tap into your energy reserves. And odds are you have a lot of them (the average body mass index has 200,000 – 400,000 stored calories). A great analogy for this is a savings account that, say after 50 years, you can’t actually access.

Eating Schedule

So, how long should you go without eating? There’s no magic number, but a key point is that like anything else, it gets easier as you practice and take small steps.

Dr. Brown has the reserves to go 3,4, even 5 days without food. It sounds crazy, but after the first day, the body’s ability to adjust is in full force. Thanks to internal timekeepers like our circadian rhythm, pancreas and liver, our body is incredibly skilled at adapting to eating schedules. Dr. Brown has eaten no earlier than noon for years, and the rare time that he does, he feels sick.

A little window into this widespread belief that we need food nearly all the time, is the hit show Alone, in which contestants must survive in a remote part of the world. What do you suspect is almost always the first concern, once dropped off in their location? Not wood for fire. Not shelter from grizzly bears.

It’s food. Should one day pass without food, most contestants will be in full freakout mode. The reality is that, as long as they have a means to hydrate, they have the ability to go a week or even longer without this food they are so obsessed over.

To be clear, this isn’t to say it’s easy. Fasting – especially prolonged fasting of a day or longer – takes time, practice, and many small steps. But with 44% of America being obese, the idea of skipping meals couldn’t be much more important.

And just like breakfast was long touted as the most important meal of the day – it is becoming the most common meal to skip, as one type of fasting is gaining popularity – intermittent fasting, sometimes known as time-restricted eating. Eating dinner at 5 or 6 PM and not eating again until 11 AM or noon the next day, has proven successful and not too difficult for many people. And it’s a great stepping stone that Dr. Brown would recommend to most people.

Liquids, Hunger, & Fasting

Hannah explains a hunger-related scenario she experiences often, that many of us do too. She notices that if she eats a later dinner, or even snacks at 9 or 10, she will feel hungry the moment she wakes up.

There are various causes for this sensation, an important one being the disruption of sleep if its occurring shortly after eating. But another cause actually isn’t hunger-related at all. 

It’s thirst. And thirst is a huge problem, as 70% of Americans are chronically dehydrated.

Distinguishing hunger from thirst can be harder than many think. It’s why Dr. Brown tells his patients that, following their bariatric surgery, getting enough sugar-free liquids (water, broth, etc.) is far more important than any food. And these patients see the difference right away. They wake up, and sure, feel hungry. But they hydrate, then feel great.

Prolonged Fasting & Benefits

What better way to learn about fasts lasting longer than a day, than by hearing about the experience directly. Four times a year, Dr. Brown fasts for 2-3 days, starting after a dinner at around 6 PM.

A couple benefits of prolonged fasting that surprise some, are mental clarity and energy boosts, Dr. Brown sure enjoys them, and they are also widely reported among those who fast for similar durations. After all, why wouldn’t fasting provide energy? We all know of those 2PM crashes after a big lunch. Coincidence? Probably not.

Ketosis

You may have heard about the ketogenic, or “keto” diet”, and you’ve just as likely seen items on grocery store shelves with “keto” labels. That’s tricky, but first let’s start from scratch.

We have different types of fuel. Fat’s one, and it’s a much cleaner fuel than the alternative, which is sugar. When the body burns fat, some goes to the liver, and some produce ketones. Ketosis occurs when ketones are present in your blood, and is generally a healthy sign. It is not to be confused with the dangerous diabetic ketoacidosis, during which excess ketones are in the blood stemming from the body not being able to produce enough insulin.

Speaking of, you’re probably familiar with the term “insulin resistance”. That’s one of many harmful results of too much sugar, serving as fuel for too long. Additional harm comes in the form of inflammation and oxidative stress to the cells. Overall, when you think of what happens when sugar is our primary fuel, you can think of clogging a system. 

And as for those “Keto” labels on food items – your best bet is to steer clear, and stick to whole foods containing healthy fats. It’s that simple.

Modern Medicine & Treatment

Many of the diseases killing millions of us – heart disease, cancer, diabetes, even simple aging – are largely driven by the overarching inflammatory problem – the inability to tap into stored energy.

We’ve gotten better at treating symptoms of disease: joint pain, poor sleep, low blood sugar, and everything in between. But we’ve not made nearly enough progress in treating that core problem – lack of metabolic flexibility. We are built to be lean, mean fighting machines. But it’s all about putting ourselves in those situations where we don’t eat when we don’t need to, and over time, gaining that metabolic flexibility.

We all have more capacity than we may think, and we have a ton of potential if we just don’t beat ourselves up too much. Ask questions, be curious, experiment, and take small steps toward regular fasting so you can live longer, all while feeling better.

Brain Over Belly is available wherever you get your podcasts. Subscribe now for this second episode of a special two-part series on heart disease, and others discussing weight loss, general health and longevity. Brain Over Belly, get it on Listen Boise today. What have you got to lose?

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Tipping Point: Aging, Oxygen, and Why We’re Dying Earlier

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We all age. It’s inevitable, and it’s normal.

But something else is developing that’s far from normal, and it started five years ago – before COVID.

For the first time since World War II, life expectancy in the U.S. is declining. And that’s despite advancements in medicine & technology. 

For such a troubling statistic, few people are discussing it. Is COVID a factor? Sure, but the story is much bigger, and we could just be at a tipping point of a crisis long in the making.

Why Life Expectancy is Declining

43% of Americans are obese. 67% are overweight.

While there are improvements in medicine and treatments, one aspect of general health is largely ignored – prevention, and this data on American weight highlights it. Common causes of these earlier deaths are directly correlated with obesity, which really started ramping up in the late 1970s and early 1980s.

And it’s not slowing down. Each annual report shows a one percentage increase, sometimes even two percent, in obesity. And obesity goes hand-in-hand with a specific kind of damage to our bodies – oxidative stress.

Oxidative Stress and Aging

Picture a baby just born, drawing its first breath of oxygen. Critical, right? We all need oxygen.

The irony is that oxygen – particularly oxidative stress – contributes to aging and ultimately our death. Oxidative stress is the progressive inability to use oxygen as we’re designed to. It comes naturally with age, however it grows much more damaging when metabolic disease is present. And that leads us to the two pillars of aging.

The Two Pillars of Aging

Imagine a savings account. You make regular deposits, building up for a comfortable retirement. Sounds great right?

Now imagine being unable to access it. You could have $1 billion tucked away, but what good is it if you can’t use it?

It’s a metaphor for the first pillar of aging and what many of us are doing with our bodies; we have a constant ability to store fuel, but we are losing the ability to access and burn it.

The second pillar is the loss of the ability to recover. But what exactly does “recover” mean?

Think about lifting weights. What’s actually happening in the short term, is damage, tiny little tears to the muscles used. Now, the benefit of exercise isn’t the act itself – it’s the repair, the body healing itself. And the same applies to anything – colds, a broken hip from a fall, even daily stress. Bottom line, resilience is huge in fighting aging.

How to Slow Aging

It’s a common question Dr. David Brown discusses with his patients at both Idaho BMI and Everest Surgical Institute.

There are a lot of answers, and all of them are touched on in some form in previous episodes of Brain Over Belly. But two stand above the rest.

Exercise directly affects both pillars of aging. When you break a good sweat – cardio, weights, you name it – you’re accessing and burning stored fuel. Also, you slightly break down your body, so that it can – you guessed it – repair, rebuild, and recover.

One small note; Dr. Brown exercises while fasting. Many others do too. It’s not only possible, but it enhances that access to stored fuel.

Fasting is the other major tool that slows aging, and in similar ways to exercise. Deprive your body of constant fuel, and it has no choice but to go to the reserves! Fasting also reduces many of the markers of oxidative stress, helping the body to heal itself.

In addition to exercise and fasting, good sleep, hydration and mindfulness practices also are great tools for fighting aging.

Muscle Loss & Aging

This is a hot topic that so far, just lacks definitive answers. But Dr. Brown does have a suspicion for why we lose muscle over time.

Insulin resistance goes up with age – and people who are insulin resistant break down muscle at a higher rate. In America today, when we see an increase in people’s insulin resistance as they age, it only makes sense they’d experience muscle loss as well.

So circling back to exercise; it not only maintains muscle due to regular use, but it also reduces insulin resistance. It’s a total win-win.

Food and Aging

Several studies have shown that the quality of people’s diets decline with age – the jury’s still out on why, but it’s well established that people eat less protein and more carbs as they age. Cue oxidative stress!

Now, there’s something that can really reverse oxidative stress – a molecule called glutathione. People are very familiar with protein, which are built from twenty amino acids. Well, nine are considered essential – our bodies simply cannot synthesize or produce them.

It just so happens that in nature, the best source by far for these essential amino acids is animal protein. In fact, it’s almost impossible to get enough methionine – a building block of glutathione – from non-animal sources.

It’s not that Dr. Brown is “pro-meat” or “anti-vegetarian”. He’s pro-health, and the data is simply clear. If you want to slow aging, prioritize animal-sourced protein in your diet.

Five Ways to Live Longer

In closing let’s just recap five ways to fight aging and enjoy longer, healthier lives while feeling great.

  1. Exercise to build & maintain muscle mass
  2. Fast in some way
  3. Work on sleep, ideally getting eight hours and at consistent times
  4. Drink plenty of water
  5. Eat meat

Brain Over Belly is available wherever you get your podcasts. Subscribe now for this second episode of a special two-part series on heart disease, and others discussing weight loss, general health and longevity. Brain Over Belly, get it on Listen Boise today. What have you got to lose?

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Heart Disease Part 2: Prevention

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Did you know that the most common first symptom of heart disease is sudden death? 50% of Americans with heart disease – hundreds of thousands of people each year – die before they even know they have a problem..

That’s why prevention is so important. 

The good news is we can prevent it. Here’s how, based on science, studies & first-hand experience of Dr. Brown with hundreds of bariatric surgery patients at Idaho BMI & Everest Surgical Institute.

Six Ways to Prevent Heart Disease

To prevent heart disease is to prevent oxidative stress, a key topic of the last episode of Brain Over Belly. And most of what you need to do will sound familiar if you’ve listened before, but their importance bears repeating in the context of breaking the overwhelming chronic chain reaction called inflammation..

First is diet, hands down. Americans eat far too much sugar, carbs, and polyunsaturated fatty acids. When we consume these things, or even less suspecting ones like vegetable & seed oils, roughly half of them are already oxidized. That means a quicker start to inflammation and damage to our bodies. Aside from a diet of healthy fats, skipping meals entirely is enormously beneficial. Fasting lowers oxidative stress because it lets the body repair itself.

Beyond the food realm, exercise is the third best avenue of prevention. And it’s a bit tricky, because exercise actually causes oxidative stress in the short term. Think about lifting weights. What’s actually happening is damage; tiny little tears in muscle. Well that may not sound good, but your body repairing that damage is what makes it resilient in the long term.

After a good workout, what do you feel like you need? Water, and most of us need more of it even when not at the gym. It’s estimated 70% of us are chronically dehydrated. And that means more than just thirst! It can mess with our hormone levels and increase anxiety. Many studies also back the relationship between hydration and lower oxidative stress.

Next is sleep, probably the best source of general bodily repair. We’re built to follow the sun and operate at a healthy circadian rhythm; that means being active during the day, winding down and getting to bed early at night. Small tip – you may know melatonin is a popular sleep supplement these days. Well, when your circadian rhythm is in good form, you really shouldn’t need to supplement. Your body will produce all the melatonin you need if you’re taking care of yourself.

Lastly, a great way to reduce oxidative stress is to better manage your daily stress. Look, we all have it. It’s not about getting rid of it, but handling it. Mindfulness practices like resonance breathing, meditation and even cold therapy can directly reduce oxidative stress.

Bariatric Surgery to Improve Heart Health

We’ve covered the things you can do to ward off heart disease. Now for some exciting new stuff science can do. 

A recent study showed that a large group of patients who underwent bariatric surgery had their risk of heart attack and death drop by 56% within four years. 56%!

And it gets even more promising. It’s not just morbidly obese people; anyone who carries risk factors for heart disease and is eligible for bariatric surgery could experience this life-changing benefit. 

Multiple diabetes organizations have come out in support of what they call metabolic surgery, or bariatric surgery, for treatment of diabetes. It’s just another indication of what bariatric surgery can do beyond strictly weight loss. On the most fundamental level, it limits that inflammatory chain reaction which leads to heart disease.

Key Takeaways

The numbers are grim now, sure. But the future is promising. Dr. Brown’s experience in medicine is really a highlight of how. In years past, not many peers would give much value to his beliefs and systems, which were drawn from the data he knew well. Now, he’s gained much more traction, and that is credit to medical professionals opening themselves to new ideas about how to best prevent and treat heart disease.

As for us, we can all do something to lower our risk of heart disease. It’s just about the small steps, and seeing how you can improve them every day. Tiny things like an extra glass of water, to get you an extra hour of fasting, have massive benefits in helping you achieve a longer, healthier, more enjoyable life.

Brain Over Belly is available wherever you get your podcasts. Subscribe now for this second episode of a special two-part series on heart disease, and others discussing weight loss, general health and longevity. Brain Over Belly, get it on Listen Boise today. What have you got to lose?

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Our mission is to provide outstanding medical treatment that’s affordably priced so you can achieve your weight loss, nutrition, and health goals. Our Quickstart program speeds up this mission for those who qualify. Candidates must meet specific criteria. Submit your information below and we will get back to you with details.

Heart Disease Part 1: The 12 Steps to a Heart Attack

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100,000. 

Since we’re talking heart disease this month, you may think that’s the number of annual deaths from it. It’s not.

Not close to it.

100,000 is just the gap between heart disease, the #1 killer in America, and the next most common cause of death. 700,000 people died last year of heart disease, continuing a decades-long trend that simply isn’t improving. 

And the most common symptom is sudden death. Not much we can do after that happens!

Heart disease is such an important, deadly topic that one episode just wouldn’t be enough to cover it. So we’re doing two, starting with a fresh look at the cause of heart disease. Then, in a couple weeks, we’ll be back to tackle treatment and prevention. 

What is Heart Disease?

We’ve talked a lot about inflammation in past episodes, and heart disease is really the direct result of it.

It’s an inflammatory chain reaction. Coronary artery disease (CAD) is the most common form of it and the most common road to heart attacks or cardiac events.

Now, while heart disease has its name for obvious reasons, a lesser known fact is that the hallmark signature of it – the narrowing of arteries – actually occurs throughout the body. The heart just gets the most attention because it’s working 24/7.
This narrowing is brought about by LDL cholesterol, specifically damaged LDL particles, migrating to the wall of the artery (we covered healthy vs. damaged cholesterol in a previous episode). And look, nobody on earth has perfect cholesterol. But there is a threshold. Too much damaged LDL, and your arteries pay the price, and if they do for too long, your heart will too.

12 Steps to a Heart Attack

Above are the broad strokes. What follows is a much deeper dive on the cause of heart disease, from the early, pre-symptom stages to the dreaded heart attack, which kills over 50,000 people a month.

1. Excess reactive oxygen species.

The mitochondria is the powerhouse of the cell. When we burn dirty fuel, these powerhouses still have to use it. Too many carbs, sugar and polyunsaturated fats generate ROS, or reactive oxygen species.

2. Oxidative Stress

Like cholesterol, ROS are not inherently bad. But too much creates oxidative stress. Think of rust, that same greenish-brownish process you see on older ships, abandoned cars and so on? Well rust is iron oxide, and that same harmful process can occur inside us with too much ROS.

3. NLRP3

That oxidative stress activates an inflammasome known as NLRP3, resulting in something you may have heard in COVID conversations – a cytokine storm. This has been shown in studies to be a primary driver of coronary artery disease.

4. Sialidase & Neuraminidase

These enzymes are very important in life. They become activated by NLRP3 which causes chemical reactions in the body.

5. Sialic Acid

Okay, a big one here:

  • Sialidase & neuraminidase cut off sialic acid from proteins throughout the body. Used on cell surfaces, sialic acid is a key communicator in our bodies. This cutting damages the LDL cholesterol particle, making it easier to be oxidized. Because it’s damaged, it’s no longer recognized by our LDL receptor.
  • The sialic acid cutting also damages the glycocalyx, a very small inner lining of our blood vessels. This damage to what is almost a protective carpet, makes the migration of bad LDL easier.
  • Antibodies go on high alert due to the cutting of sialic acid, because of the body now perceiving more foreign intruders. They then become more likely to bind to these harmful invaders.

Stepping back a bit, the following steps come not just from scientific data, but hundreds of first-hand observations from Dr. Brown while performing surgery at Idaho BMI or Everest Surgical Institute.

6. Spleen & Filtration

Damaged LDL travels to the spleen, which acts as an excellent filter for us. It exposes our blood to immune cells including the macrophage. Think of this as a sort of Pac-Man, recognizing the damaged LDL and gobbling it up to destroy it.

7. Macrophage

The problem is, the macrophage keeps part of the bad LDL to share with the other immune cells (B & T lymphocytes), to spread the word so to speak. Well, that starts a cloning of antibodies to recognize and destroy that damaged LDL.

8. Spillover Effect

A healthy immune system is able to get rid of damaged LDL thanks to a normal spleen. But when the amount of bad LDL becomes too much, a ripple effect of damage occurs. Atherosclerosis and high inflammation begin, along with visceral fat, insulin resistance, even anxiety and high blood pressure.

9. Migration

Because of the accumulation of oxidized LDL particles, they migrate to the wall of arteries – and it’s easy for them, due to that damaged protective carpet, the glycocalyx, mentioned earlier. This damage is occurring in the arteries of many areas, not just the heart.

10. Narrowing

Over time, that damage becomes scarring and fibrosis in the cell wall. That scarring obviously takes up space, which means your arteries have less of it – they have narrowed.

11. Reduced Blood Flow

The coronary arteries supply blood to the heart. At this stage, they don’t do it well. Some people will have chest pain in this scenario because their heart muscle cells aren’t getting the oxygen they need.

12. Heart Attack

When the blood flow is so limited that heart muscle cells start dying (often in stress or physical activity), a heart attack occurs. Afterward, the heart tries to repair itself, but often forms scar tissue where muscle cells used to be. This can lead to heart failure, arrhythmia, remodeling and other issues.

And that’s the road to the most common cause of death in America. It’s not an enjoyable one, and not an enjoyable topic.

However, there is a ton of optimism for getting ahead of heart disease, and not even just from Dr. Brown. For decades, treatment has largely ignored prevention, and that’s where we as a society can make massive improvements.

This prevention, which can allow us to live longer while feeling better, will be the focus of Heart Disease Part 2 in just a couple weeks. Stay tuned!

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Stress, Insulin, and Cells Eating Themselves: The Truth About Exercise and Protein

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Exercise and protein. Mobility and meat. There are thousands of books, blogs, and videos on these topics, so it’s easy to feel confused. 

Truth is, exercise is not the key to losing weight. It’ll help, but when it comes to burning calories, it’s actually pretty inefficient. To burn 1,000 calories, you would have to run – not walk – for hours. And it’s important to eat the right protein to feel right.

So what is exercise good for? Quite a lot.

Six Best Reasons to Exercise

1. Brain Health

Most of us are stressed these days. Really stressed. But the release of endorphins that comes from exercise is proven to relieve stress and anxiety. Exercise also helps maintain brain cells. BDNF is an extremely important chemical that when released, can help generate new brain cells. Good sleep also means a good brain, and exercise helps both the duration and quality of your sleep. So whether it’s feeling rested, happier, or keeping your memory sharp, exercise works wonders for our mental health.

2. Insulin Resistance

Think of a savings account. Now imagine not being able to withdraw from it. Crazy right?

That’s similar to what most of us are doing to our bodies in our modern lifestyle. We can store energy (fat), but our poor diets and habits have made it far more difficult to access that fat, withdraw it, use it as fuel. And insulin resistance is a huge reason.
Exercise is proven to increase insulin sensitivity, which is what you want to have because the insulin your body produces will be more effective. After his many years seeing patients at both Idaho BMI and Everest Surgical Institute, Dr. Brown would say insulin resistance is the one thing he would magically fix if he could. It’s that important for long-term health. And while exercise isn’t magic, it sure is a tool for reducing insulin resistance.

3. Inflammation

This one’s a little tricky but in a fun way. See, exercise actually causes inflammation in the short term. Take lifting weights – what’s actually happening is a bunch of tiny tears in the muscle, which is a form of inflammation. Now, the good stuff starts in repairing these tears. The body doesn’t just produce muscle in this stage, but develops a stronger ability to fight inflammation going forward. It’s almost a paradox. We cause a little inflammation, but later receive a much greater reward (along with muscle – more on that soon).

4. Increased Metabolism

Not all fat is the same. We actually have white and brown fat, and brown is a much better indicator of fat burning and overall metabolic health. White fat is often associated with being overweight.

So brown fat is what we want right? Well, exercising stimulates the maintenance and growth of brown fat cells. Speaking of cells…

5. Autophagy

Greek for “self-eating”, autophagy is just the proper term for when the body recycles old, damaged cells. When we exercise, the body gets a signal that it needs to be more efficient, and toss all the extra baggage not working (this is actually why fasting also stimulates autophagy). Autophagy is deeply connected with improving inflammation, insulin sensitivity, sleep and more.

6. Movement

At age 40, we start losing muscle. That’s just life, and it has huge implications on our health and longevity. Keeping muscle means less stress on joints, which means less arthritis, better movement, and more activity in your later years – wrestling with the grandkids, gardening, hiking, you name it.

The Key to Exercise: Consistency

Other than poor form with too much weight, there’s really not a “bad” kind of exercise. Dr. Brown normally lifts weights because he’d say maintaining muscle is slightly more important than cardio. But if you enjoy cardio, the runner’s high is real, and it is good for you!

We all differ in capabilities. After all, Dr. Brown has patients in wheelchairs. But everybody can do something. Be safe and listen to your body, but push yourself a little bit. And remember that consistency is often more important than intensity. A good analogy is water and rock. Water’s very soft, but over time, even a tiny trickle can have a tremendous effect on rock, sculpting and shaping it. Just look at the Grand Canyon! That process is what exercise can do to our bodies.

Three Truths about Protein

Moving on to protein – another topic of debate and misinformation. Dr. Brown has answers that may not be popular with some of you, but they are based on scientific fact.

1. Animal Protein is Better than Plant Protein

Absolutely. Proteins are made of amino acids. Our bodies can’t make some of them, so we have to get them elsewhere. Well, that “elsewhere” is almost exclusively animal protein.

2. Protein Drinks are not as Good as People Think

Correct. There’s a perception that protein drinks are a magic shortcut. Even Dr. Brown used to drink them. But not only is protein from whole foods better, it doesn’t have the heavy metals many protein powders do.. 

3. You Don’t Need as Much Protein as You May Think

True. Yes, protein is important, but that doesn’t just mean more is better. Think back to autophagy – one of the things the body recycles is protein. So no need to obsess over it.

Best Kinds of Protein

Meat and eggs, pure and simple. Cheese if you don’t have an allergy or react negatively. These types of animal products aren’t just great sources of protein, they’re nutrient dense all-around.

Summarizing Exercise and Protein

There’s an ocean of info on these topics, but remember the key points: consistency, do whatever it is you enjoy, push yourself a little bit, avoid injury, drink water and prioritize meat, eggs and cheese.

Perhaps most importantly, we all differ. It can be easy to judge ourselves too harshly or compare ourselves to others. But try comparing yourself…to yourself. What can you do today, that can be even slightly improved tomorrow, then next week, then next month? Small investments like that have enormous payoffs for the rest of your life.

Brain Over Belly is available wherever you get your podcasts. Subscribe now for this episode on the microbiome, and others discussing weight loss, general health and longevity. Brain Over Belly, get it on Listen Boise today. What have you got to lose?

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More Than a Number: The Role of Cholesterol and Why It’s so Misunderstood

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We hear a lot about cholesterol from our doctors, we see commercials for it left and right, and it’s often regarded as bad. But that’s just not telling the whole story.

Cholesterol is Necessary for Health

If we didn’t have cholesterol in our bodies, we’d die. It’s a fundamental building block for cells and hormones, so why does it get this bad wrap?

For almost 60 years, the wide belief has been that high cholesterol levels drive heart disease, coronary artery disease, atherosclerosis and more. It is true that plaque along our arteries can result in these – but to say that cholesterol is the main driver of heart problems is flawed.

LDL (low-density lipoprotein) is widely regarded as a bad cholesterol (you’re told to have less of it), but it’s an incomplete description. HDL (high-density) is sometimes referred to as good cholesterol (you’re told you want more of it), because it’s thought that when it’s low, it’s associated with risk factors of developing diabetes, cardiovascular disease and more. So what’s wrong with these assumptions?
Dr. Brown says think about knees. He sees many patients at Idaho BMI and Everest Surgical Institute who have needed knee replacements. It would be easy to just say, based on all these people, knees are bad! A human knee is weak, let’s just replace everyone’s. LDL is just like that – it serves the very important function of delivering fat to be burned as fuel. The problem is when the LDL particles become damaged. That’s the bad cholesterol. But just having a higher than normal LDL level in the blood doesn’t necessarily indicate trouble’s coming.

So What Causes LDL to Go Bad?

Most of us know of rust, and may even know it’s when iron has been oxidized. Thing is, that same process is what damages LDL particles. They become oxidized. Then, the actual bodily damage comes from our cells not recognizing these damaged LDL particles. Eventually, the body reacts to the damaged particles as if they were foreign, and that triggers the immune system to attack it – just like it’s trained to do. Finally, that immune response is what creates the inflammatory build up on the walls of our arteries.

Saturated vs. Polyunsaturated Fats

Damaged LDL cholesterol results from eating too many carbs, sugars, processed foods, and something we’ve not touched on a lot – polyunsaturated fats. 

You’ve heard of essential fatty acids, maybe omega-3s, and those are great. The problems are the inflammatory omega-6s and omega-9s, which (ironically) some health organizations actually recommend people eat more of. 

You can test for your omega levels, and science shows the healthiest ratio of omega-6 to omega-3 is 1:1. But guess where Americans fall? 16:1 on average, of omega-6s to omega-3s. That’s far too much polyunsaturated fat.

Much like cholesterol, the common belief that saturated fats are bad for you stems from old, poorly-performed studies. More recent studies have shown no association between saturated fats and atherosclerosis, and Dr. Brown would even say saturated fats are the body’s preferred fuel.

What to Cook With, What Not to

This confuses some people, because some of the worst oils have “good” names in them (vegetable oils, seed oils). Even cheap, processed olive oils can be harmful. 
Tests on these oils have shown they’re already oxidized, so your LDL particles invariably become damaged when you consume them. Saturated fats on the other hand, are much less likely to become oxidized. Healthy alternatives to inflammatory oils include butter, tallow and ghee.

Cardiologists and “Low” Cholesterol

It’s understandable why cardiologists stress lowering cholesterol. What they see every day are people with coronary artery disease and heart disease, so they’re about intervention, not prevention. This leads to the biggest question of the episode. What can we do proactively to reduce our bad LDL, and keep our good LDL? Dr. Brown suggests you lower insulin resistance and inflammation, by getting good sleep, sticking to a healthy diet and fasting.

Now what about when that annual check up comes, and you look at your cholesterol results with your doctor? The first thing is to not make any decisions based on one number (and there will be a lot of them). Instead, use those numbers to look for patterns. Dr. Brown likes looking at the ratio of triglycerides to HDL. You want triglycerides to be low and HDL to be high, because that is the indicator of insulin sensitivity, low inflammation and good LDL health – even if your LDL score is higher than normal range. In fact, this pattern suggests your body is doing a great job of  burning fat as fuel.

The Final Word on Eggs

Dietary cholesterol affecting the cholesterol inside us is mostly a myth, and it’s why many recommend avoiding eggs, which are high in cholesterol. But the body is elegant, and fully able to regulate that. In fact, the American College of Cardiology and American Heart Association have dropped their recommendation to avoid eggs. Dietary cholesterol is simply not the thing they thought it was. Eggs are good!

In short, the human body is amazing. With so much going on inside it, it’s easy to forget the big picture. And that’s where the issue of cholesterol became a problem. It’s not that current beliefs are 100% wrong, they’re just incomplete. But thankfully, great science and easier access to information is improving our understanding more and more every day.

Brain Over Belly is available wherever you get your podcasts. Subscribe now for this episode on the microbiome, and others discussing weight loss, general health and longevity. Brain Over Belly, get it on Listen Boise today. What have you got to lose?

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Why You Can’t Ignore the Microbiome if You Want to Lose Weight

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37.2 trillion. That’s approximately the number of cells in our bodies. But that’s nothing compared to how many microorganisms we have just in our intestines. 

That collection is what makes up the microbiome, one of the most popular areas of health science over the past decade. It contains things we may think of as bad, like bacteria, viruses, even fungi. But in the right combination, they’re really just the opposite – helpful. As many as 100 trillion microbes line our intestinal tract, playing a huge role in the health of our bodies and brains.

Why is the Microbiome Important?

“The second brain” is a common nickname for the gut for good reason.

The brain and the intestinal tract are constantly communicating with each other, and our tens of trillions of microbes have a lot of say.

Think of serotonin, something most of us know to be in the brain and involve feeling good. Well, it does involve feeling good…but 90% of it isn’t in the brain. It’s in the gut.

And that’s just the beginning. In addition to mood, things directly affected by the microbiome are weight, the immune system, metabolism, even brain function. So without a healthy gut, everything from diabetes and obesity, to autism and dementia, depression and anxiety, is at greater risk of occuring.

The Microbiome and Weight Loss

It is nearly impossible to lose weight with an unhealthy gut, and a famous study shows why.

It involved two groups of rats, one an average weight and the other obese. In what’s called a fecal transplant (gross, we know, but hear us out), stool taken from one group and transplanted into the other, actually would change the weight of the receiving group over time. So the obese rodents would lose weight, and the lean ones would become obese.
Scientists are still working to verify if and how this transplant technology can benefit us humans, particularly for C. diff colitis. If it can, the health improvements could be massive. In the meantime, make note that an unhealthy microbiome means more hunger, more cravings, and more difficulty maintaining a healthy weight. Who wants that kind of struggle?

Brain to Belly

In our brain to belly connection, the vagus nerve is like the main freeway. It’s our biggest influencer, sending electrical signals based on the fuel we’re giving it. Eat a bunch of bad stuff, and over time this important nerve will lose its signaling capacity that the brain relies on.
This explains why the microbiome is best viewed as a messenger. Give it bad information like sugar, carbs and hyper-palatable foods, and the brain will receive and be forced to use it. And our entire bodies pay a price. It’s all too common for patients that come to see Dr. Brown at Idaho BMI and Everest Surgical Institute.

Taking Care of Your Microbiome

Like most other habits Dr. Brown recommends, the small and simple stuff goes a long way. Eat the right stuff, at the right time, and try fasting when you can. Get good sleep. Stay hydrated, and try to limit stress. Making these habits long-term is especially important because the microbiome is extremely dynamic, meaning it reacts very quickly to however you treat it. Indulge in a piece of cake, and you’ll likely fight cravings for a couple days. But also, eat only healthy fats for a few meals, and your microbiome will thank you.

Biotics

There’s growing evidence that antibiotics are overprescribed these days, because of how much we’ve learned about them damaging the microbiome. On the other hand, prebiotics and probiotics help the microbiome. Sure, you can get them in supplements, but the best way is by eating them. Yogurt is a popular food that’s loaded with healthy cultured bacteria. Leafy greens and any fermented food such as kimchi is going to treat the gut very well.

Overall, just don’t judge yourself too harshly as you introduce these tiny habits to enjoy great gut health, and the brain health that comes with it. The body is very complex, but with small steps taken to treat it right, there’s nothing like seeing and feeling the results.

Brain Over Belly is available wherever you get your podcasts. Subscribe now for this episode on the microbiome, and others discussing weight loss, general health and longevity. Brain Over Belly, get it on Listen Boise today. What have you got to lose?

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Fasting: Why Skipping Meals Gives You a Better, Longer Life

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“Three meals a day is healthy!”

“Breakfast, the most important meal of the day!”

We’ve all heard ‘em, and most of us were probably taught them. In fact, some professional trainers and dieticians recommend four to six smaller meals a day, often to “increase metabolism”.

And it’s just not true, according to Dr. David Brown of Idaho BMI. But before he explains why, let’s start with the basics.

What is Fasting?

Fasting is not eating food. Plenty of water is important, as is being mindful of electrolytes and vitamins. There’s no perfect length of time to fast, but generally the longer you can go without food, the more beneficial it becomes. And it’s not something you’re likely to pick up overnight; you need to practice, which will allow your body to adapt. 

Dr. Brown knows this first-hand. Years ago, before heading to the operating room every day, he just had to have breakfast. If not, he’d be frustrated and grouchy. Jump to today, and it’s the complete opposite; if he eats before noon, he feels sick. This illustrates just how much the body is capable of when you can give it time to adopt a new, healthy routine.

Fasting & Energy

‘If I don’t have food I don’t have energy”. Most of us either feel that or have heard some form of this. Dr. Brown has heard it time and time again at his Idaho BMI and Everest Surgical Institute clinics. 

Thing is, the body is just more sophisticated than that. Think of batteries. Many people charge them right after use regardless of how much juice is left. But guess what improves performance and extends the battery’s life? Letting it drain almost entirely before charging.

Our bodies aren’t much different. We must cycle in and out of fasting because fasting is as important as eating. Our bodily systems become dysfunctional when we don’t allow them to reset, to clean themselves out. And that’s exactly what fasting does. 

How Long to Fast

Don’t worry about a magic number of hours. Just try to extend the time you go without food. If that’s 24 hours like Dr. Brown sometimes does, great. If it’s 15, nice work. You may even work your way up to prolonged fasting, which means no food for three, five, even seven days. Sounds crazy, but it’s not only doable, it’s hugely beneficial.

Fasting and Weight Loss

Being overweight means having excess fat reserves. If the body never needs to tap into those reserves because it has a constant supply of food, it won’t. That’s weight gain. 

Fasting burns the stored fat because…that’s all it has. That’s weight loss. This is the reason the myth of starvation mode (going without food slows metabolism) is false. 

Bears hibernate, right? To prepare, they want to store fuel for that long period of no food. So they eat and eat, and then what do their bodies do? Signal to slow metabolism so they can conserve energy. 

We get that same signal when we eat all the time. Our body thinks it needs to conserve energy (fat) when it’s always consuming, because it thinks a long period without food is coming.

Other Benefits of Fasting

Nearly all the scientific literature shows that most of our systems – brain & memory, muscles, the immune system – improve with fasting.

Think back to our ancestors thousands of years ago. It was the norm to go without food for extended periods. It only makes sense that the body would signal to be more alert, active, and focused so it could hunt or find food.

It would also signal to be more alert against disease. See, our immune system has two parts. One part remembers exposure to bacteria and viruses (think chicken pox). The other part is just chronic, unregulated inflammation, something getting worse in this time of hyperpalatable foods and overeating. 

Fasting improves both parts, by lowering inflammation and enhancing the memory within the immune system. In fact, there is strong evidence that vaccinations can be more effective in people who regularly fast.

Finally, we recently discussed ketosis, and how fasting triggers it along with better cognitive function. So you’re not just looking and feeling better when fasting, you’re actually thinking better.

Getting Started Fasting

Try skipping breakfast. Drink lots of water and see if you can make it until noon to eat. Then just see how you progress. When can 1:00 PM be your first bite? When can you achieve the final goal of one meal a day?

Dr. Brown’s own routine goes back to the opening point of allowing the body to adapt. He will sometimes fast for two days, and guess what? After about 24 hours, it actually gets…a little easier. There’s no drop in energy, and he loves the mental clarity it brings.

Daily life even gets easier when fasting, especially if you’re busy. Dr. Brown has a patient who travels frequently, and all over the globe. His favorite aspect of reaching the one-meal-a-day goal was just how much more simple mornings and afternoons became. Always eating isn’t just unhealthy, it can be a chore.

There’s so much information out there about fasting, so just be curious. Ask questions, experiment with strategies, drink plenty of water. But the bottom line is if you want to live a long and happy life, time without food is time well spent.

Brain Over Belly is available wherever you get your podcasts. Subscribe now for this episode on fasting, and others discussing weight loss, general health and longevity. Brain Over Belly, get it on Listen Boise today. What have you got to lose?

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