Weight loss program Q&A with experts

[MUSIC PLAYING] Hello, and welcome to the
University of Chicago Medicine At the Forefront live. The purpose of our
program is to allow you to interact with our
doctors live on Facebook. So get your questions
ready, and we'll answer as many as we possibly
can over the next half hour. Now, we want to remind our
viewers that our program today is not designed
to take the place of a medical consultation
with your physician. Joining us today is Dr. Edwin
McDonald and Dr. Christopher Chapman. They'll be speaking with us
about healthy weight loss options available here
at UChicago Medicine. I'll start off with the two
of you introducing yourselves. Kind of tell us a little bit
about your areas of specialty. Absolutely. So I'm one of the
advanced endoscopists here at the
University of Chicago. There's three of us here. So I do a lot of procedures that
deal with pancreatic cancer, other diseases like that. And one of my focuses is
on endoscopic treatments for obesity. And that's what I like to do.

Great. Dr. McDonald? So I'm also one of the
gastroenterologists here. I specialize in nutrition. So that means I
basically see people who suffer from malnutrition. So people with
short bowel syndrome who need alternative
ways to get nutrients in. And I also do weight management. So I also do some
of the procedures that Chris mentioned, but also
focus on medical weight loss, which is essentially talking
about diet, exercise, and then people who qualify maybe
even using medications. And you're also a chef. We're going to talk a little
bit more about that later. I'm also a trained chef. That's pretty exciting. That's great stuff. It is. I love doing it. I haven't had his
food yet, though. Really? Well, I should have
you over sometime. I think so. I think so. I think that's an
official invitation. Yeah, that was an invite. We have a witness
here, so that's great. You heard it here now. Absolutely. Well, many people
have had their lives changed the healthy
weight loss options available at UChicago Medicine. Let's hear from one
of our patients, who had a wonderful outcome.

I walked from my apartment
to the lake and back. And that was something
like 6,000 steps. And you know, it's not something
I could have done a year ago. So I'm really happy about that. I'm happy. My wife's happy. Everybody's happy. Gregory Fulham is
doing things he hasn't been able to do in years. The success has been dramatic. Gregory had a
procedure performed by Dr. Christopher Chapman
called endoscopic sleeve gastroplasty. The procedure is
quick, and the results can change lives dramatically. The advantages of
the endoscopic sleeve gastroplasty are that it's
an outpatient procedure. There are no incisions,
so there is no scarring. And the healing time
is drastically reduced. The endoscopic
sleeve gastroplasty is a noninvasive
procedure designed to reduce gastric volume. Sutures are put in
the stomach, reducing the size of the stomach. Stomach volume is
reduced by 50% or more. Patients eat less, because
they become full more quickly, and are satisfied
with smaller portions. You feel full sooner. And that's a good thing. The University of
Chicago Medicine provides a full range
of bariatric services.

For some patients, this
is the perfect solution. Others, though, will
require surgical procedures, also available at the
University of Chicago Medicine. We're happy to see
any patient who would be interested in
procedures or other methods for weight loss. However, for this particular
endoscopic sleeve gastroplasty procedure, we're
looking for patients who are really in need
for that jump start to lose about 30 to
60 pounds of weight. Patients go through a
process before the procedure to make sure they're
ready for this step. After the procedure,
they will be expected to change
their lifestyle, eating less and exercising more. At University of
Chicago Medicine, we pride ourselves on our
multi-disciplinary evaluation. That includes seeing
a psychologist, an endocrinologist, a
dietitian, as well as a gastroenterologist. We have the patients see all
these providers before we even do the procedure.

Gregory says the
procedure went very well, and the changes to
his lifestyle have been surprisingly easy to make. I eat the same stuff that
I have been eating forever. I just eat less. The procedure had Gregory in and
out of the hospital in a day. He says the care has been great. It's really a privilege to
be in a neighborhood that has an institution like this so
handy and so ready to assist. It's wonderful. See, that was I think
pretty interesting, because it really showed
what a difference that made in Gregory's life. I mean, he was talking about
these changes, and the fact that he can walk
and get around now.

Which is really neat to see. Absolutely. He's had a remarkable journey. And you know, he
keeps telling me– I see him where he is
employed– and he tells me how much of a difference
it's made for him. Great. And Dr. McDonald,
I imagine you see a lot of patients that
are in the same situation, where their lives are
literally transformed. Oh, definitely. I mean, I've seen people– I think the most weight loss
I've seen in our clinic so far maybe went probably close
to 150 pounds or so. So that makes a huge
difference in people's lives, as far as mobility,
as far as happiness, as far as just day-to-day,
everyday interactions. So I know both of you are– what you preach to your
patients is healthy weight loss, and healthy is the
important aspect of that. Let's just start off talking
about what exactly that means. What's the difference
between healthy weight loss versus non-healthy weight loss? So for me, I think
it's better to define what unhealthy weight loss is.

And that's a good
place to start. So unhealthy weight loss– you know, I see a lot of people
who try these starvation diets. So these different fasts,
where people are just drinking water for days on end. And a lot of those diets, it's
really just not sustainable. So I think healthy
weight loss is something that is going to have
a sustained effect over time. And it is a pattern of eating
that someone can actually stick to and continue with,
as opposed to something that is going to lead to issues
over a certain period of time. So there's a lot of different
very, very low calorie diets out there that for the most
part will lead to weight loss. But you can really only do
those for about a month or so. And eventually, most
people, all the weight is going to come back. So what we tend to
focus on is really a way of eating that
people can carry out throughout their entire life,
as opposed to just one month or just a couple of months.

Because again, like I said,
we want the weight loss to be sustainable. It's a lifestyle change. Yeah. I agree. And as Ed and I were
talking together– we work very closely together–
that this is not just a single moment of change. This is a lifestyle
change that we want to do. And that's why the
multi-disciplinary approach that we see with
Ed working on some of the medications
and the procedures that we do together, where the
focus is more about providing durability for those patients
that yo-yo up and down with their weights. Because they do a fad diet. They crash. And they get down, but then
it's ultimately unsustainable. And then they end up having
these problems again.

So we're trying to find
these ways to build not only a medical relationship,
but a personal relationship that allows us to make
long term changes. And when people yo-yo
like that, it's not only hard on them physically,
but emotionally as well, I would imagine. Yeah. And it's actually harder
to maintain the weight loss when you go up and down. Primarily, every time
you go up and down, that's associated
with hormonal changes. And that can impact your long
term weight loss overall. So the way I view weight loss,
it's almost like a pyramid. And you have to
have the foundation. Without the foundation,
the whole pyramid is going to fall apart. But there will be maybe
multiple rungs on the pyramid or rungs on the ladder. So lifestyle modification
is really the foundation. But for a lot of people–
for most people– studies show that lifestyle
modification on its own may not be as effective. And that's why we
provide these adjuncts. And so you have medications. You have bariatric and
endoscopic therapy. Then we also have
bariatric surgery. And each of them can
play an important role, depending on what the individual
patient is going through.

Full continuum of care here. A full continuum of care. Great. I do want to remind our viewers
that if you have questions for either one of
our physicians, just type him in on Facebook,
and we'll get to him as quickly as we can. We have our first
question from a viewer. And that is, is BMI the best
way to gauge a healthy weight? So BMI is the way
that we use commonly primarily because for
research purposes, we do have to have some
sort of classification, and also to decide
whether or not people would benefit
from bariatric surgery or medications.

We need some sort of marker
to make those decisions, and BMI based upon studies
has become that marker. But there are a
lot of limitations when it comes to BMI. So BMI is not a reflection
of your muscle mass, nor is it a reflection
on differences in terms of ethnicity. So certain ethnicities
may just in general carry a higher BMI
or a lower BMI. So for instance, according
to research studies, people of Asian descent may
have a lower BMI to begin with.

But that does not
necessarily mean that they don't have obesity. So someone may not have
a BMI that puts them in overweight category. But if you actually
look at their fat mass, technically they're
functionally over weight. And BMI is not capturing
that population. So BMI is just one
metric that we use. But it's not the sole
metric, by no means. We look at other things,
like waist circumference. Things like that. Or also we really look for like
kind of visceral adiposity, or fat volume we're
talking about. So I agree with Ed
that BMI in itself is not the only tool
that we use and should be using to assess
someone's weight status. Great. We have another question
from a viewer that asks, how do you know if you
should be considering bariatric surgery or
endoscopic procedure or something else like
medical weight loss? And I'm going to throw
that one to you first. Sure. So since we have the
wide spectrum of care here going all the way
from lifestyle management to medications to
bariatric endoscopy all the way up to bariatric
surgery, what we try to do is work very closely with
the whole group to decide what's the best for the
patient individualized.

And so our general guidelines
are based on a BMI. So if you have a BMI
between 30 and 40, that might make you
a good candidate for endoscopic
bariatric therapy. However, if you have
a BMI greater than 40, oftentimes bariatric surgery
is the most effective option to treat your obesity issue, as
well some of the complications that arise from
the weight issues. And so either a BMI greater than
40 or a BMI of greater than 35 with co-morbidities should
be considered for surgery. However, if you look at
medications, even a BMI of 27 would be an indication to
consider medical management to help with weight. So we can use the BMI
as a starting point. But then we do tailor
it to individuals. So if someone has a BMI
in a higher class that is more interested in
endoscopic procedure, that may be better
than nothing at all. it really depends
on the patient. But we kind of use the BMI
as a first starting point. And Ed, how do you feel? Yeah, I totally agree
And what Dr. Chapman here means by co-morbidities
is really the other conditions
that may be associated with gaining extra weight,
or just other conditions in general.

So say someone has
severe lung disease. That may put them at
risk for complications from bariatric surgery. We may have to consider
alternate options that aren't as invasive. Or if someone has
severe diabetes and we know they need to
lose weight immediately, bariatric surgery may
be the better option, just because we know it's a
little bit more effective, especially with a BMI over 40. And I think Ed brings
up a great point about the timing and the need. So we deal at
University of Chicago with a lot of patients with
significant health problems in addition to weight issues. And so we're in
constant communication with our transplant surgeons,
our orthopedic surgeons, our OBGYNs. We deal with fertility issues. These are patients who, if
they're struggling with these conditions, sometimes helping
them lose a little bit body weight– even 10%– can make a
significant difference for their outcomes
for other procedures or their plans for
their families.

I've got to get to
a couple of things, because we have some
props here that you brought that I'm fascinated by. And so if you could
kind of explain to us what we're seeing here. And we were talking a little
bit during the video that aired a few moments
ago, and there was an animation that showed
one of the procedures you do. And you brought in some things. Right. So currently, there are
about three procedures that are FDA-approved, or the
device is FDA-approved for use. And these are
endoscopic procedures, meaning that we use a flexible
tube with a camera on it to go down through the
mouth and do interventions on the stomach. So there's no cuts
or no incisions. The wound healing
is not really there, because it's all internal.

It's very discreet. And so these are the
options that we're kind of employing from
the endoscopic side. And there's the
intragastric balloon here. You see it's a silicone balloon. There are about three that are
FDA-approved on the market. They're fluid-filled
or gas-filled. They're about the
size of a grapefruit. They stay in your stomach for
a period about six months, and then we take it out. So this is a very nice
option for those patients who are looking for a
very reversible option.

Because once you
remove the balloon, you're completely
back to yourself. The other option that we
do is the endoscopic sleeve gastroplasty. This is a where we use
a suturing device here that allows us to actually
take full thickness bites through and
through the stomach wall to tighten the stomach. And we kind of call this
the accordion procedure, because you're basically folding
it and closing it on itself. And this is the one
that Gregory had and had such a great response. So you can see that you use
this device and a handle that allows you to close and
basically pass a suture and take bites of tissue. And then I'll let Ed
here finish and talk about aspiration therapy. Because we both do
this therapy here. Yeah. So there is aspiration
therapy, which is basically where we place
a small tube in the stomach. And the tube allows people
to empty out at least 30% of their calories that
they take in a given meal.

So you know, it's
actually just a variation of a common procedure
that we do all the time as gastroenterologists, which
is a Percutaneous Endoscopic Gastrostomy tube, also
known as a PEG tube. So typically historically,
we do the PEG tube for people who can't eat. They have swallowing issues or
issues with their esophagus, and we have to feed them
directly in the stomach. But with this tube, It's
a little bit different. So this allows people
to basically empty out their stomach just a little bit. But one, you have to chew
your food very carefully. So you just can't empty out
everything you're eating. Two, it's always done in a
context of lifestyle change.

So it's not a tool that
people can use and just eat whatever they want and
empty whatever they want. Doesn't work exactly like that. So people are seen by
myself and our dietitians, and even we have psychologists
involved that help us out with the whole process. You know, that to me
is I think critical. Because this isn't
just a procedure. When you both do your
work, you involve a lot of folks in the process. And it is about a
lifestyle change. It's really from beginning
to end with them. Right. You need a full
evaluation for this. Because it is such
a drastic change. A lot of time, people are
battling 30-40 years of habit that they've built
up that they're trying to suddenly change. And kudos to them for coming
in and starting that process.

But because it is
so challenging, we acknowledge that we have
to ask our patients to meet with a dietitian
and a psychologist to make sure that we're
moving in the right direction and it's going to be safe. Great. Now we have a question
from one of our viewers. Stephanie is asking, she
sees every one or two years there's a new fad
diet that comes out. I think keto, Whole30, paleo,
there's a bunch of them. Are these realistic for
patients to do diets like this? Does it help? Is this more of a hindrance? What are your thoughts? I mean, everyone's a
little bit different. And I think whenever we
see someone in clinic, we don't automatically tell
them just to do Keto, or tell them just to do x diet. We really have to take
an individual approach to understand what people's
taste preferences are, what their ability to
afford certain foods, where they live at. So access is an issue. So we take all these different
things in consideration. But what a lot of these
diets have in common, ultimately you're avoiding
ultra-processed foods.

So there's no diet that
really tells you to eat a whole bunch of potato chips. Or other foods. Or other ultra-processed foods. And then most of the diets
really involve some sort of calorie restriction. So there's a lot
of debate out there in terms of where we should
place those calories. Should those calories
be mostly protein? Should those calories be less
fat or less carbohydrates? But when you look at a
lot of different studies, ultimately when people
decrease their caloric intake– their calorie intake–
people tend to lose weight.

And if you add
exercise to the mix, you're even going to
lose even more weight. So fundamentally,
just eating less and eating more healthier
foods that aren't processed is going to be the foundation
to any of these diet programs. Now, there are some diets out
there that are just unsafe. And most of those
diets are really where you're doing like
800 calories or less for extended periods
of time, where you're putting yourself at risk
for starvation and also protein loss.

So you know, I
tend to tell people to be careful with
those, and also be careful with
things that sound like it's too
miraculous to be true. So if there's a diet that
says the miracle diet, the miracle diet
really does not exist. And if the diets really
just focus on supplements, typically a lot of
supplements don't really lead to a lot of weight loss. So case in point,
there's like the HCG diet out there, where
people are taking a lot of HCG, which is a hormone
associated with pregnancy. You know, that diet has been– it's out there in
the literature. But the diet has been
studied, and it's not as effective as what
people claim to be. So ultimately, what I tell
people with these diets, you really have to
do your research. And a lot of research
should include talking to a registered dietitian. Not necessarily a nutritionist. If they are a
nutritionist, you really have to find someone
who's certified, as opposed to
someone who is online claiming to be a nutritionist.

scale diet fat health 53404

Which that happens. We have another viewer who– there's a procedure that they
had done called the roux-en-Y. Is that correct? Roux-en-Y. Gastric bypass. Yeah, it didn't maintain. But they want a new beginning. What would you tell
someone like that? Right. We see a lot of patients who
have had bariatric surgery, and then unfortunately
have regained weight. So I think when we bring them
into our clinic to discuss, we actually just try to find
the underlying reason why they've had weight regain. Is it something behavioral? Or is it something mechanical? And if it's mechanical,
sometimes we can actually try to
repair those things. The repair could be surgical. So bariatric surgery
definitely has a role, like a revision
bariatric surgery. But also we're using this
endoscopic suturing device to do certain things as well. So a lot of times, we
find that the opening of the stomach to the
small intestine is dilated. So it's stretched out
in size over time.

And this typically happens
anywhere from five to eight years post-operative. And you can actually
use this device to suture down that opening to
make it tight again to provide that level of restriction. So one of the key
questions I ask my patients when they come in with
this problem is, do you feel any restriction? Or can you eat more food
than you could before? And so those are
different things that we want to try
to get at to try to see if maybe there's a
mechanical component that can be doing this.

And even sometimes
people may form what we call a gastrogastric
fistula, where there's actually an abnormal connection
from their pouch into their old excluded stomach. Because with a bypass, your
old stomach is still there. So there's a chance,
actually, when you eat, the food you're going is
back down the original path. And so we kind of do a
full range of evaluation to see is there's
something mechanical, or is there
something behavioral? And we go from there. Dr. McDonald, can we talk
about coffee a minute? I'm pointing at your
UChicago Medicine mug. I've got to get
the plug in there. But talk a little
bit about coffee, because we were discussing
this a little bit before the program
began, and some of the benefits of black coffee. So lead us down that
path, if you will. I mean, for me, I'm probably
a coffee addict since years ago when I became a resident
and had my first kid– my wife and I first kid– when I was an intern.

So coffee became mandatory. And since then, I
just have not stopped. Overall, coffee
is pretty healthy. So there's a lot of concerns. A lot of times people come
in to me and in my clinic and say things like, I stopped
coffee, I stop spicy foods. And I'm like, wait
a minute, where did all this negative
connotation come from when it comes to coffee
and spicy foods and stuff like that? Because ultimately, a lot
of these foods are healthy. So black coffee by itself
has been associated with decreased risk
of liver cancer, and maybe even decreased
risk of heart disease. Now, when you add a lot of
sugar and a lot of cream some of the fancy
lattes and everything that have a lot
of calories, that can be associated
with weight loss. And also, those
aren't very healthy, because it's again
simple sugars. And that's probably more along
the lines of the processed food category. So there are some
recent concerns about coffee and cancer.

Specifically in the
state of California, at least at Starbucks
and other coffee stores, they have to put a label
explaining the risk of cancer with certain types of coffee. So a lot of that risk or
a lot of those concerns comes from studies
on mice, but not necessarily studies in humans. So most of the
studies in humans, again, show that coffee
decreases the risk of cancers. But the concern really comes
from the fact that coffee, especially when it's roasted–
so like our darker roast coffee– may have higher amounts of a
carcinogen– a cancer causing agent– called
[? acro ?] aromatase. But that's also
found in potatoes. It's also found in bread. It's also found
in a lot of foods that we roast in the oven. Now ultimately, how
much does it take? You know, how much exposure
to [? acro ?] aromatase does it take to cause cancer? I don't think
anyone really knows that, because to set that up
to answer that question, you'd have to do an unethical study,
where you're just giving people [? acro ?] aromatase
for many years and then seeing what happens.

So we don't know. But ultimately, I drink coffee. I probably drink maybe a
little bit less dark roast. But I don't really have
any concerns about it, for my own well-being. One of the questions
too that's coming in kind of along the same
lines, and it deals with cancer. But the link between
obesity and cancer. Would either one of you
care to comment there? Right.

I mean, so there's definitely a
link between obesity and cancer as well as outcomes related
to cancer therapies. If you look at breast
cancer, for example, that there have been
plenty of literature published and well-done
studies suggesting that if you have obesity
and are undergoing treatment for breast cancer, that your
outcomes are less favorable. So we know that there
is definitely a link not only to the
development of cancer, but also to the outcomes
related to therapy. So this is another reason why
I think some of these options should be on the
table for patients, even when they're battling
some of those very strenuous conditions. Interesting. So another question. Many of these popular diets
or high protein diets. And the concern is,
is there a correlation between all that protein and
possibly having kidney stones? Not necessarily. So it depends on one,
someone's personal history with kidney stones. Because there's
multiple different types of kidney stones. Most of the stones are really
based upon calcium, not necessarily protein intake. Now in the past, especially
like in the '90s, everyone was concerned about eating too
much protein and that causing kidney failure.

So I remember years
ago when I was playing football and sports,
and people were trying to do protein shakes. And all the coaches were
like, don't do too much, or else you're going
to get kidney failure. That is not true. So that has all been debunked. And a lot of people– even
people with kidney disease– actually need protein,
up until a certain point where they need dialysis. Then you really just need
to talk to a dietitian and make sure you're
not overdoing it.

But for the most part,
the protein concerns and kidney disease,
you really don't have to be concerned too much. Because most people aren't going
super crazy with the protein. Another one of our
viewers says, I have a PCOS and a
slightly high A1C. Would an endoscopic weight
management procedure be beneficial to
helping me lower my A1C? Yeah, I think that's
a great question.

Unfortunately, one of the
common presentations of PCOS is weight-related
challenges in addition to menstrual cycle
irregularities or having irregular periods. And so the treatment of PCOS or
using an endoscopic management, it really gets to
the bottom line is, does it also
help with treatment of those conditions that
are associated with weight, such as diabetes or
high blood pressure? And there are
literature out there that suggests that these
endoscopic procedures, when they're capable to lose that
10% to 20% of your weight, can improve hemoglobin A1C, can
improve people with fatty liver disease, can improve people with
blood pressure or cholesterol problems. So yes, for that
person out there, I would say that
if you do have PCOS and you're struggling
with weight, this could be a viable option
to help you get over that hump and get you out of that.

We see a lot of patients who
are in that pre-diabetes phase, and they say their
numbers are borderline. If they're trying to
correct that issue, weight loss will help try
to get them back down out of that range. So people with that borderline
diabetes, that's a signal. That's an alarm sign
that's just going off saying that we need probably to
do something more aggressive. Whether that's lifestyle,
whether that's endoscopic, whether that surgery is
very tailored to the person. But that's an alarm
sign for people. Because these things can help. Can I answer that? Yeah, absolutely. So also, PCOS can
be very complicated. And it's something
that really requires a multi-disciplinary
team to manage. So here at the
University of Chicago, we have people seeing
endocrinologists. We work with the gynecologists. And then we also
work with ourselves as weight loss specialist
and endoscopist. So I think that approach is
going to be individualized. But it's probably
going to take input from a lot of different
doctors to decide what's the best overall approach. Absolutely. Because there are
medications that are great treatments
for PCOS too.

Like a lot of patients
are on metformin, which also is an a blood
sugar control medicine. So that may be enough to
help this person get out of that range with a
mildly elevated A1C. So as Ed mentioned,
we work very closely with the endocrinologist
to make sure that they're in
the right approach. We don't just offer
one thing and say that this is what we do.

But you have to look
at the whole picture. And sometimes, procedures
aren't the right option. Sometimes medications are. But we do tailor it
individually, I would say. Another viewer question. I've heard that women's
hormones make it more difficult to lose weight. Would you approach a woman's
weight loss treatment differently than
you would a man? No. I mean, for the most part, yes. So women can have a harder
time to lose weight. But at the end of the day,
really, lifestyle modification is the foundation. And those changes are the same. Reducing calories,
trying to exercise, sleeping, not trying
to sleep too little, not sleeping too much. And then from there, we decide
based upon other conditions people may have
whether or not they're a candidate for bariatric
surgery, medications, or endoscopy.

But ultimately, the
equation, if you will, is relatively similar. It just so happens to be a
little bit more difficult, especially in women who
are post-menopausal. Yeah. We see a lot of women
patients actually come in who are interested
in endoscopic therapies. And in fact, our
most frequent patient are really those patients that
have had their second child, and they just can't
shake the weight after their second
or third child. And so there is definitely
a gender difference that I've seen in my practice
in terms of how people do. But men do well
with the procedures and with lifestyle
changes as well. But I think it is something
that we do try to tailor.

And we look at other things
that they're going through. Women may be more likely to
have thyroid disease than a man. So we have to ask those
kinds of questions and make sure those conditions
are ascertained or assessed as well. And so there are other things
that we look at same time. Another question from a viewer. Vegan diet, yes or no? Yeah. I mean, it depends on
your taste preferences and what you're really into. So if you want to do fruits
and vegetables and be a vegan, you can do that
in a healthy way. But you really have
to be a healthy vegan. So I've seen unhealthy
vegans where, they're just eating
potato chips, and they're calling
themselves a vegan. And technically, you can
be on a potato chip diet and be a vegan.

But that is an unhealthy diet. Or you could just eat pasta
all day and be a vegan, but you're not eating
fruits and vegetables. So I remember I was giving
a community lecture, and someone came up to me
and said they're a vegan. And I asked them like, oh,
what's your favorite fruits and vegetables? And they said, they hate
fruits and vegetables. And I'm like, how
can you be a vegan and you hate fruits
and vegetables? So that is an example of
being an unhealthy began.

But vegan as a whole,
a lot of studies show that people may
live a little bit longer, if you look at some of the
Seventh Day Adventist studies. They may potentially have
a decreased risk of cancer. So for some people, that
is a very viable option. People who are interested
in becoming a vegan, you have to be aware of the
possibility of B12 deficiency.

So that's something
that definitely occurs in the vegan population. But outside of that, you
really just have to make sure you're a healthy, which
applies to any diet. And I would imagine you just
have to watch your intake of– Yeah, the macronutrients. Making sure you get a protein. What are the protein sources
that are vegan-compatible. Those are why you see a
registered dietitian or someone like Dr. McDonald who
can help you understand what those macronutrients– What is a good protein
source for a vegan, just out of curiosity? So you'd have to have
multiple protein sources. Primarily because there are
a few plant-based proteins that have all your
essential amino acids. So the only ones I
can think of offhand, quinoa is a complete
protein that's plant-based. And I believe amaranth is also. But everything
else, you're going to have a combination
of different seeds, different nuts, and
different beans. And using that
combination will get you all those essential
amino acids, which are kind of the building
blocks of protein.

We're about out of time, but
we do have one more question from one of our viewers. Keto diet, good or bad? It can be good if
done appropriately. So a lot of studies
show that the keto died for people
who have seizures can decrease the
risk of seizures. It plays a role
in it, especially in people who have epilepsy. It may help out with
people who have migraines. And people can lose weight
with a ketogenic diet. Now, the ketogenic diet is still
a relatively recent phenomenon, so in terms of
long term effects, I think we need to do a
little bit further studies. In terms of how it
affects our gut bacteria, those studies also
need to be done and are actively being done. And I think some
of our researchers, specifically Jane Chang is
looking at some of those, trying to answer some
of those questions.

But from a weight loss
perspective purely, people can lose weight
with a ketogenic diet. But at the end of the
day, most of these diets are really restricting
your calories, and really cutting back on some
of these ultra-processed foods. Dr. Chapman, any
parting words for us? No. I think this was fantastic. I hope everyone learned a lot. And you know, I hope you got
a taste of how Ed and I work very closely together, and that
we are here to help people. And if you have any
questions, we're always happy to reach out. Definitely. Perfect. And we want to stress
the continuum of care. Because there are a lot of
services that are available here at UChicago
Medicine for folks that want to lose weight
and change your lifestyle in a safe manner. Yeah, absolutely. So I see people with
a bariatric surgeons.

For people who are candidates
for bariatric surgery, I tend to at least
recommend they have a conversation with
a bariatric surgeon, just so they can see
what their options are. Absolutely. Great. If you want more
information about UChicago Medicine's weight
management program, please visit our website site
at UChicagoMedicine.org/weight management. It's there at the
bottom of the screen. Or you can call 888-824-0200. Thanks for watching
At the Forefront live, and have a great week.

.

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