Aspirin Prevents Lung Cancer

We’ve previously seen that low-dose aspirin use prevents cancer, and does so by a number of mechanisms, such as iron chelation and AMPK activation. For this brief report, I want to note also that aspirin use prevents lung cancer.

The reason for doing so is that lung cancer is of course associated with cigarette smoking. If aspirin prevents lung cancer, then it says something about the mechanism of lung cancer as well as its ability to counteract tobacco carcinogens.

Report 1: Aspirin and lung cancer in women. Odds ratio for lung cancer in women who used aspirin more than 3 times a week was 0.66, i.e. a 34% reduction in lung cancer incidence.

Report 2: Regular aspirin use and lung cancer risk. Odds ratio 0.57, and a greater reduction with longer duration of aspirin use.

Report 3: Chemoprevention of lung cancer by non-steroidal anti-inflammatory drugs among cigarette smokers. Huge, 75% reduction in lung cancer risk and “only heavy smokers were included in the control group”, i.e. a comparison of smokers with cancer and those without. Of interest, ibuprofen was also associated with lower risk, OR 0.39.

Report 4: Aspirin Use and Lung, Colon, and Breast Cancer Incidence in a Prospective Study. 32% less lung cancer (and 30% less breast cancer). In this study, aspirin use was characterized only once, when participants answered a question as to whether they used aspirin in the previous 30 days. If they had used aspirin longer, presumably risk would have been lower.

I’m personally interested in this topic for 2 reasons: 1) I’m a former smoker, and cancer risk lasts a long time; I quit over 30 years ago, so knock on wood, but you never know; 2) it shows that aspirin, which is literally the world’s cheapest drug, has untapped potential for health.

Hundreds of millions of people globally smoke cigarettes, and aspirin could prove a huge benefit to them, since obviously many of them aren’t interested in quitting, or can’t quit.

Aspirin: saving more lives than statins at 1% of the cost.

By the way, green tea cuts lung cancer risk radically.

For more on cancer, see my book, Dumping Iron.

PPS: Check out my Supplements Buying Guide for Men.




Protein Fights Fatigue

Many people have vague health complaints, that they just don’t feel well or are tired all the time. (I’ve been there.) Regular doctors often can’t find anything grossly abnormal about them, so there’s nothing to treat. Then these people end up in alternative medicine (I’ve been there too) and see these doctors for a long time and spend lots of money, often without result, when a simple dietary change could vastly improve their condition. That’s because protein fights fatigue.

Alternative medicine

Alternative medicine has its good points. Half of it is very effective, but the problem is figuring out which half. In any case, it’s been my experience that “integrative medicine” doctors and other alternative practitioners are willing to stay on their patient’s case and keep trying, for which they deserve kudos, while in regular medicine, doctors often ascribe patients’ untreatable symptoms to the pateints’ imagination.

Who goes to alternative doctors, though? Lots of them are people who are already acquainted with alternative health practices and already practice some of them themselves.

Vegetarians, for example.

Even if not complete vegetarians, they may believe, as large numbers of people do believe, that meat, eggs, and cheese are unhealthy and to be minimized. Meat, eggs, and cheese (and other dairy products, and fish) contain large amounts of complete protein and are, in my view, necessary for good health. While vegetarians could have a reasonably good diet if they include eggs and dairy, I believe it’s next to impossible for a vegan to eat well.

Protein and fatigue

So, apparently large numbers of people have vague symptoms that cause them to seek medical help. While the symptoms can be vague, they can be severe, such as unrelenting fatigue.

I also see what most people eat, and it’s not healthy. Bagels or breakfast cereal are not healthy breakfast options. Pizza isn’t a healthy dinner.

But even those attuned to their health often end up having green smoothies and a banana for breakfast. Those aren’t healthy either; one of the main ways they’re not healthy is because they provide next to no protein, and no animal protein at all.

In my view, it’s no wonder that people who eat like that are fatigued and don’t feel well.

They probably have low levels of glutathione; the body requires amino acids from protein to make it.

Indeed, whey protein increases glutathione in young adults with cystic fibrosis. Inadequate glutathione levels may be involved in the pathogenesis of chronic fatigue syndrome.

Muscles require protein; muscles fractionally break down and build up, and that’s strongly attuned to fasting and eating, so even if someone is not trying to build muscle, he or she needs adequate protein just to prevent muscle loss. Without adequate dietary protein, a person risks slipping into a chronic catabolic state, and this is exacerbated by other illness. Among the illnesses that feature a chronic catabolic state are “HIV infection, cancer, major injuries, sepsis, Crohn’s disease, ulcerative colitis, chronic fatigue syndrome, and to some extent in overtrained athletes.” [My emphasis.]

Protein helps overtrained athletes return to health

Elite athletes train hard and train often, and that can lead to overtraining, a condition in which the athletes become fatigued, unable to train at their usual intensity, and subject to upper respiratory infections.

In overtrained athletes, blood levels of amino acids are abnormal. Provision of ~30 grams of extra protein daily returned these athletes to health and to their usual training schedule.

“Analysis of these results provided contrasting plasma amino acid patterns: (a) a normal pattern in those without lasting fatigue; (b) marked but temporary changes in those with acute fatigue; (c) a persistent decrease in plasma amino acids, mainly glutamine, in those with chronic fatigue and infection, for which an inadequate protein intake appeared to be a factor.

If extra protein can help elite athletes get back to health, could it help ordinary people with chronic fatigue? While the ultimate causes of chronic fatigue and overtraining may be different, the two conditions likely have some commonalities, and a chronic catabolic state caused by lack of sufficient dietary protein may be one of them.

A significant number of adults, estimated at 10 to 25%, do not eat the RDA for protein, and in fact, the RDA itself may be set too low.

It’s likely that many people with vaguely defined symptoms such as fatigue might return to health if they increased their dietary protein intake. Even a relatively small additional amount could make a difference. For example, eating eggs instead of cereal for breakfast could make a meaningful difference, or having chicken instead of pasta for dinner. Or adding 25 grams of whey to lunch.

Animal foods are high in the complete protein people need to be healthy and energetic and comprise:

  • meat
  • eggs
  • fish
  • cheese and yogurt

If you’re feeling fatigued (or overtrained) enough to seek medical attention, and you’re eating a diet low in protein, the answer may be more protein.

For much more on fighting fatigue, see my book, Smash Chronic Fatigue.

Smash Chronic Fatigue: A Concise, Science-Based Guide to Help Your Body Heal, and Banish Fatigue Forever by [Mangan, P. D.]

PPS: Check out my Supplements Buying Guide for Men.




Anti-Aging Drugs Rapamycin and Metformin Decrease Iron

Anti-aging drugs rapamycin and metformin decrease iron.

Rapamycin and metformin are the most touted drugs with the potential to increase human lifespan.

The noted scientist aging research Vladimir Anissimov says that in metformin, we may finally have an anti-aging drug. Metformin is currently undergoing a clinical trial for anti-aging purposes.

Another noted scientist of aging, Mikhail Blagosklonny, believes that “rapamycin will become the cornerstone of anti-aging therapy in our life time.”

There’s been much speculation and research into how these drugs can extend lifespan. It’s thought that metformin acts by lowering glucose and insulin levels, and rapamycin by decreasing activity of mTOR, the cellular growth mechanism that also drives aging.

But it turns out that both of these drugs also affect iron, dramatically.

Metformin

Metformin is the most-prescribed diabetes drug in the world. It’s a derivative of a plant whose activity has been known for hundreds of years.

In women with polycystic ovary syndrome, an illness in which insulin resistance plays a role, metformin lowers ferritin in only 3 months of treatment.

Below is a graph of ferritin levels in women treated with metformin. (Top graph, metformin is open circles.) Ferritin declined dramatically. Another drug (closed circles) had no effect.

Figure 1—

Luca Mascitelli suggests that improvement in polycystic ovary syndrome with metformin treatment is due to decreased iron levels. He also suggests that the improvement in non-alcoholic fatty liver disease with metformin is also due to a decrease in iron. Metformin probably does this by inducing a decrease in dietary iron absorption.

Rapamycin

A common side effect of treatment with rapamycin, which is used for transplant patients, is iron deficiency anemia. Those patients on a different drug did not become anemic.

Rapamycin’s best known mechanism in life extension is the reduction in activity of mTOR (the mammalian target of rapamycin). Yet iron activates mTOR, and iron chelators deactivate it. Perhaps rapamycin deactivates mTOR through its actions on iron.

Iron promotes aging

Iron promotes aging. I’m going to be going to my grave (ha ha) saying this.

Is it possible that the main anti-aging benefits of both metformin and rapamycin are due to lower body iron stores? Yes.

Is it possible that you could get all the benefits of these drugs just by lowering body iron stores on your own? Yes. Is it probable. Yes, I believe it is.

Don’t wait for anti-aging drugs

You may be waiting a long time for anti-aging drugs, although some doctors will prescribe rapamycin, and more of them metformin. (OTC berberine is a reasonable facsimile of metformin anyway, and it may be even better.)

So keep iron in the low normal range; learn how with my book Dumping Iron.

PS: Check out my Supplements Buying Guide for Men.




Cancer As a Metabolic Disease and Iron

The theory of cancer as a metabolic disease states that metabolic aberrations, not gene mutations, cause cancer. (Previously discussed here.) In this article I’ll discuss how iron can plausibly be an initiator and enabler of cancer in accordance with the metabolic theory of cancer.

Background

In another article, we saw that there are good grounds for thinking that iron causes cancer. In brief, those grounds are:

  • iron reduction via phlebotomy lowers cancer rates
  • iron chelators (substances that bind and remove iron) fight cancer
  • body iron stores are associated with cancer
  • iron causes hypercoagulation, which is associated with cancer
  • carcinogenicity of iron has been unequivocally demonstrated in animal experiments
  • iron is associated with the carcinogenicity of asbestos and tobacco smoke

Iron causes cancer. But how does it do this?

Cancer as a metabolic disease

If the theory of cancer as a metabolic disease is true, then the main defect that causes a normal cell to become cancerous is metabolic injury, specifically a switch from mitochondrial aerobic respiration to aerobic glycolysis. In his article on cancer as a metabolic disease, Thomas Seyfried discusses how this happens, or could happen.

In brief, cells require a certain level of energy to remain viable. If something injures mitochondria, where respiration (burning of fuel for energy) takes place, then the cell falls back on the much more inefficient process of glycolysis to provide energy. It has no choice but to do this to remain alive. If mitochondria are damaged beyond repair, then glycolysis continues, and the hallmarks of a cancerous cell appear as a consequence.

This sequence can explain how many different factors can cause cancer: radiation, chemicals, viruses, and inflammation. And iron.

Iron and mitochondria

Iron is intimately involved in mitochondrial function. Mitochondria play a key role in synthesizing various iron-containing proteins, such as heme and iron-sulfur proteins.

Friedrich’s ataxia is a neurological disease that results from a defective or deleted gene that controls iron metabolism in mitochondria, leading to 10 times the mitochondrial iron as normal.

Perhaps most importantly, excess iron damages mitochondrial DNA.

The accumulation of iron and damage to mitochondria are both characteristic of aging, and aging leads to far greater rates of cancer. Cancer rates among those aged 65 and up are about 10 times those of younger people.

Quality control of mitochondria has a crucial role in counteracting the aging process.

Iron accumulation damages mitochondria:

Iron is an essential mineral for normal cellular physiology, but an excess can result in cell injury. Iron in low-molecular-weight forms may play a catalytic role in the initiation of free radical reactions. The resulting oxyradicals have the potential to damage cellular lipids, nucleic acids, proteins, and carbohydrates; the result is wide-ranging impairment in cellular function and integrity… There is substantial evidence that iron overload in experimental animals can result in oxidative damage to lipids in vivo, once the concentration of iron exceeds a threshold level. In the liver, this lipid peroxidation is associated with impairment of membrane-dependent functions of mitochondria and lysosomes. Iron overload impairs hepatic mitochondrial respiration primarily through a decrease in cytochrome C oxidase activity, and hepatocellular calcium homeostasis may be compromised through damage to mitochondrial and microsomal calcium sequestration. DNA has also been reported to be a target of iron-induced damage, and this may have consequences in regard to malignant transformation. Mitochondrial respiratory enzymes… may be key targets of damage by non-transferrin-bound iron in cardiac myocytes. Levels of some antioxidants are decreased during iron overload, a finding suggestive of ongoing oxidative stress. Reduced cellular levels of ATP, lysosomal fragility, impaired cellular calcium homeostasis, and damage to DNA all may contribute to cellular injury in iron overload. 

In his paper and book, Seyfried emphasizes the role of damage to cardiolipin, a phospholipid important to the mitochondrial membrane.

Alterations in mitochondrial membrane lipids and especially the inner membrane enriched lipid, cardiolipin, disrupt the mitochondrial proton motive gradient (ΔΨm) thus inducing protein-independent uncoupling with concomitant reduction in respiratory energy production. Cancer cells contain abnormalities in cardiolipin content or composition, which are associated with electron transport abnormalities. Cardiolipin is the only lipid synthesized almost exclusively in the mitochondria. Proteins of the electron transport chain evolved to function in close association with cardiolipin…

Cardiolipin abnormalities in cancer cells can arise from any number of unspecific influences to include damage from mutagens and carcinogens, radiation, low level hypoxia, inflammation, ROS, or from inherited mutations that alter mitochondrial energy homeostasis. Considering the dynamic behavior of mitochondria involving regular fusions and fissions, abnormalities in mitochondrial lipid composition and especially of cardiolipin could be rapidly disseminated throughout the cellular mitochondrial network and could even be passed along to daughter cells somatically, through cytoplasmic inheritance.

To summarize these above two points:

  • iron can damage mitochondrial membranes
  • damage to those membranes, especially of the easily damaged membrane component cardiolipin, could lead to cancer.

Iron could be the proximate cause of many or most cases of mitochondrial damage, such that other causes of cancer, such as chemicals, radiation, viruses, inflammation, etc., work by causing the release of free iron from ferritin and heme. In normal circumstances, iron is tightly controlled, locked away inside ferritin, transferrin, and other molecules. Damage to ferritin, for example, could lead to free, reactive iron being released, which in turn damages mitochondrial membranes, leading to cancer.

Consider that radiation, including solar radiation, causes cancer. Radiation damage to skin is dependent upon iron.

By adding or chelating iron, UVA radiation-dependent oxidation of sulphydryl groups of bovine serum albumin and human γ-globulin was shown to be iron-dependent.

Topical iron chelators dramatically delay the onset of UVB photodamage in mice. Kojic acid, a cosmetic ingredient, prevents skin wrinkling from photodamage by chelating iron.

Consider that anthracycline, an anti-cancer drug, produces significant toxicity in cardiac tissue by damaging cardiolipin, the mitochondrial membrane constituent whose importance in cancer Seyfried emphasizes. Anthracycline toxicity can be prevented by treatment with iron chelators in vitro.

Inflammation induced by endotoxins causes the release of free iron which then damages mitochondria.

Tobacco smoke, another carcinogen, not only contains high amounts of iron but alters iron homeostasis.

Is it iron all the way down?

We’ve seen that not only is iron a carcinogen, and that iron is intimately involved in the mechanisms of many other carcinogens, but that iron specifically damages mitochondria and its membrane constituent, cardiolipin.

Therefore, damage by iron is not only compatible with the theory of cancer as a metabolic disease, but may be all but essential to it.

Iron may be the proximate cause of many or all cases of cancer.

PS: More on iron and disease in my book, Dumping Iron.

PPS: Check out my Supplements Buying Guide for Men.





blood and iron: how to optimize iron levels

How Blood Donations Deplete Iron

A reader asked me a question that stumped me at first, so here’s the question, and my answer as to how blood donations deplete iron.

Q: “How is it possible to remove as much or more iron as ordinary food rapidly replaces? When I count the number of things whose contents individually constitute 100% of “RDA” or even higher, it strikes me that I’d have to just about bleed out every day to get rid of it all.

“Can you show an “iron balance”, with quantification showing elimination rates from various actions vs intake from various foods? That would be very helpful.”

A: Your question genuinely stumped me at first. I was wondering whether I had overlooked something. A blood donor loses about 250 mg of iron from his body iron stores with each donation, out of total body iron stores of 3 to 4 grams.

According to the NIH, average daily iron intake for an adult American man is about 20 mg, although not all of that is absorbed; as little as 10% is absorbed, or 2 mg, depending on lots of factors like food macro composition, alcohol intake, sugar consumption, use of supplements, etc. Meanwhile, the RDA is 8 mg (0.8 mg absorbed) so you see the problem: intake is 2.5 times the minimum necessary, which can ultimately lead to high body iron stores (high ferritin). 

At that rate of 2.5 mg a day absorbed, in 100 days, you’ve made up for the blood donation. But we do know that donating blood lowers iron levels quite well, so what gives?

The answer is that the 2 mg of iron absorbed daily is at a steady-state of body iron. Iron overload, unless extreme (genetic or some other reason) happens over years, slowly. Somewhat like if you gain 1.5 ounces of body weight a month, in 10 years you’re 10 lbs overweight.

Normal daily iron losses for an adult man are about 1 to 2 mg. So the iron you absorb daily just keeps even with losses. If you donate blood, and lose a lot more, absorption increases.

But if you lose blood via donation, phlebotomy, or being mauled by a bear, it will take longer than 100 days to make up for your lost iron at steady-state rates. If you lose a lot of blood, absorption really ramps up. 

In my book, I calculated that one annual blood donation is enough to keep ferritin in a low normal range, assuming low normal ferritin to start with. (With a high starting ferritin, a higher rate of donations is necessary to get down into the low normal range.) That’s ~250 mg a year of iron.

I calculated here that 75 mg of aspirin might get rid of 25 mg of iron daily, which exceeds daily intake.

I trust that all makes sense. The iron you ingest daily isn’t all added to body iron, because you lose a small amount daily, and when you donate blood, the same applies.

I discussed other aspects of blood donation, iron, and transfusion here.

 

 




Ketone Supplements Extend Lifespan

Very Low Carbohydrate Ketogenic Diets

Eating a very low-carbohydrate diet results in the production of ketones, which the body uses as an alternative fuel source; hence these diets are called ketogenic.

The liver makes ketones from fatty acids when glycogen has been depleted, hence going without carbohydrates, or fasting altogether, ramps up ketone production, and it does this to spare glucose. While it’s been known for a long time that ketogenic diets have therapeutic uses, such as for weight loss and in epilepsy, new research is showing the relation between ketones, longevity, and cancer.

Ketone supplements extend lifespan

The ketones, often referred to as ketone bodies, are beta hydroxybutyrate (BHB), acetoacetate, and acetone.

Ketogenic diets are thought to be therapeutic for several reasons, one of the most important being a decrease in levels of the hormone insulin. Low insulin allows fat to be released from fat (adipose) tissue, hence a ketogenic diet speeds weight loss.

One of the main benefits of ketogenic diets may be the production of ketone bodies themselves. Ketones mimic many of the changes that calorie restriction causes, and ketones have been found to extend lifespan in C. elegans.

Scientists believe ketones should also extend human lifespan.

Calorie restriction works via ketones

 

Calorie restriction as a method of extending lifespan in animals has been known or a long time, maybe 80 years or so, but the concept goes back much further. Luigi Cornaro (1464-1566) sought the advice of physicians when he was in his 30s (placing the time at about 1500) when was so sick that he felt he was going to die. (I suspect that Cornaro was diabetic.) One of the doctors advised him to cut back his food intake radically, which he did, eating only one meal a day and including a healthy half a bottle of wine.  Cornaro returned to health, lived to over 100 years of age, and wrote about his experiences in his book, On the Temperate Life.

Since one of the physicians knew that cutting food meant better health, that must have been known long before Cornaro’s time.

In modern times, scientists discovered that restricting rats’ food by 10% or more made them live longer, contrary to expectations. Since calorie restriction (CR) is one of the very few interventions that extends lifespan, we’d like to know how it works. If we could discover that, we could intervene in other ways, for example with CR mimetics such as resveratrol.

Many theories have sought to explain CR, e.g. it results in less fat mass, less oxidative stress, less inflammation, beneficial changes in the gut microbiome, less insulin, less growth hormone and IGF-1, lower metabolic rate, less iron accumulation,and others. But what may have escaped notice is that CR reliably produces ketones in virtually every species.

The production of ketone bodies could account for the life-extension effects of calorie restriction, at least in part.

Maybe just as important, exogenous ketones could extend human lifespan. No need for calorie restriction or very low carbohydrate ketogenic diets (VLCKD), although the benefits of a VLCKD likely go far beyond just the production of ketones.

Giving exogenous ketones to rats decreases blood glucose and insulin. When rats were given 30% of their calories as corn starch, palm oil, or beta hydroxybutyrate (BHB, the most quantitatively important ketone body), those that got the ketones had about half the glucose and insulin levels of the group given starch. Their food intake also dropped by about half. The experiment lasted only 6 days, so no weight loss, which probably would have happened if it had gone on longer.

MCT oil, which produces ketones in humans, results in better weight loss than an equal amount of olive oil.

Exogenous ketones may extend lifespan partially by lowering glucose and insulin.  But they also increase antioxidant defense mechanisms.

As humans age, blood glucose and insulin increase, possibly as a result of decreased muscle mass and increased fat mass. Exogenous ketones (a ketone supplement) could improve these. Alzheimer’s, which has lately come to be called type 3 diabetes, could possibly be treated with exogenous ketones. (Recall the well-known N=1 study in which a doctor treated her husband’s Alzheimer’s with coconut oil.)

Ketones can treat cancer

In mice who that had metastatic cancer, exogenous ketones increased survival time by 70%. That survival time was independent of glucose level or calorie restriction. This effect looks like a direct targeting of the Warburg effect, i.e. it’s a treatment based on the metabolic theory of cancer.

Many people, even cancer patients, won’t cut their carbohydrates to get into ketosis. Exogenous ketones could help.

For anti-aging purposes also, ketone supplements could work; MCT oil probably would as well. I regularly eat a very low carbohydrate diet, but even here, boosting ketones with a supplement might be advantageous.

Ketone supplements

I’ve tried KetoCaNa, a ketone supplement, and it works; killed my appetite when I took it. Currently, I occasionally use MCT oil, since it’s a lot cheaper than exogenous ketones. You can put a tablespoon or more in your coffee in the morning instead of breakfast, get those ketones going. BTW, these are NOT raspberry ketones, which don’t work.

For more life-extending interventions, skip the Starbucks and spend it on Stop the Clock.

PPS: Check out my Supplements Buying Guide for Men.




The Dangers of Liposuction

Note from P.D. Mangan: I was recently contacted by a woman who wishes to remain anonymous. She told me some horror stories about liposuction and sent me this article, which I asked to publish and to which she’s agreed. The article explains the dangers of liposuction, something of which I was unaware, as I presume most people are unaware. After reading this article, it’s hard for me to imagine how this procedure exists, so absolutely shocking is the information here. As a neophyte to this issue, I can’t offer any criticism, but it all appears legitimate. Most of the physiology appears accurate to me. This is a long article, but in the public interest, it deserves to be published in full.

The Dangers of Liposuction

by S. L. ©2017

TABLE OF CONTENTS 

  • INTRODUCTION
  • THE HISTORY AND CURRENT STATE OF LIPOSUCTION
  • SOME COMMENTS ON THE FAT REDISTRIBUTION STUDY
  • MULTIPLE NAMES FOR SUCKING OUT FAT – NONE PROVED SAFE
  • UNJUSTIFIABLE RISK
  • LACK OF CLEAR, INFORMED CONSENT
  • COMPETING DOCTORS INCREASE PUBLIC CONFUSION
  • BOARD CERTIFIED PLASTIC SURGEONS CREATE UNDUE HARM
  • UNSOUND PROCEDURE MARKETED BY PLASTIC SURG BOARDS
  • PROCEDURE
  • THE MISNOMER OF ‘NON-ELASTIC’ SKIN
  • WHAT IS FAT?
  • FAT DISTRIBUTION
  • THE HARMFUL EFFECTS OF VISCERAL FAT
  • THIRD SPACE SWELLING
  • LONG-TERM DAMAGE
  • THE CLIENT EXPERIENCE
  • COM – MISLEADING TO POTENTIAL PATIENTS
  • ERIC SWANSON – STUDY, 2012
  • SURGICAL GUESSWORK
  • VIOLATED CONSENT
  • THE ZONES OF ADHERENCE
  • SURGEONS CODE OF ETHICS
  • FDA APPROVAL
  • OVER RESECTION
  • REGULATION ISSUES
  • LEGAL CHALLENGES – LIPOSUCTION AND THE LAW
  • FINANCIAL CONFLICT OF INTEREST
  • CONCLUSION

 

 

INTRODUCTION – 1              

 

Liposuction – the surgical removal of fat – is a nontrivial procedure that may involve a painful recovery and serious complications, [1] including but not limited to: an increase in toxic visceral fat, long-term fat mobilization, metabolic syndrome, increased insulin resistance, disturbing adipose tissue re-distribution, painful skin adherence, over-resection, muscle resection, infertility, various other structural damages, and death.

This text will explain these complications and point to studies and evidence that illustrate why the Health Technology Advisory Committee issued this caution: “Death and disfigurement due to the cosmetic surgical procedure of liposuction should be a matter for serious public concern.” [2]

According to the ‘Evidence-Based Patient Safety Advisory: Liposuction’, “Liposuction is considered to be one of the most frequently performed plastic surgery procedures in the United States, yet despite the popularity of liposuction, there is relatively little scientific evidence available on public safety issues.” [3] In 2006, liposuction was the most common plastic surgery performed with over 400,000 patients. “The increasing number of liposuction procedures has led to a growing number of iatrogenic (medically induced) fat tissue deformities, in addition to those of traumatic and disease-related nature.” [4]

Patients experience a spectrum of harm from liposuction surgery and blog online and flock to surgeons to consult about possible revisions, desperate for solutions and relief. Complaints range from disturbing fat regrowth to having skin painfully grafted to bone, and even to having muscle tissue siphoned out. Regardless of the serious complications, there is no database in which to record them in a consequential way. [5] Countless stories are not shared online because many people may not wish to publicize their personal horrors. What’s more, when reported to doctors, client complaints are often marginalized.

Disfiguration by liposuction may lead patients to risky and expensive fat grafting and/or skin excision surgeries. Dr. Juan Brou, a Board Certified Plastic Surgeon in Oklahoma, wrote a consumer warning in which he explains that “clever, misleading advertising has increased the popularity of liposuction, as well as the reports of unfavorable outcomes”. Unfavorable outcomes, he explains, are difficult and sometimes impossible to correct, especially if all of the fat stores have been removed. Dr. Brou says “patients who have experienced unsatisfactory results are often too humiliated to come forward, which could help warn others in hopes of preventing similar negative outcomes”. [6]

Dr. Brou’s 2010 consumer warning goes on to say, “Last year at the meeting for the ASAPS (American Society for Aesthetic Plastic
Surgery), a lot of emphasis was placed on how to correct deformities after liposuction.” Recall, he said that fat grafting becomes even more challenging if all or most of the patient’s stores have already been removed. [7]

Some patients notice physical disfiguration immediately, or as soon as the swelling begins to subside. Post surgical swelling, may distort the cosmetic outcome for 6 months or more, thus short-term ‘honeymoon phase’ results may be misleading. Case histories must be followed long-term. It can take at least a year often more for the some patients to understand that changes in their fat deposit patterns ruined, (and continues to ruin), their figure and/or health. [8] Patients who report early cosmetic satisfaction may go on to report ongoing pain, numbness, striated and fibrous adhesions, chronic hematomas, loose skin, diminished metabolic and hormonal health, and disturbing weight re-distribution weeks, months, and years later. Thus, patients who initially link certain complications as being temporary effects of surgical may come to realize these specific problems are permanent.

According to the report by the Health Technology Advisory Committee (HTAC), “since liposuction is an elective, pay-out-of-pocket procedure, data is not collected as to how many liposuction procedures are performed, the complexity of procedures, or the resultant complications.” [9] Clear, important statistics on fatalities and complications from private offices or surgeon-owned surgery centers may be withheld. [10]

The HTAC stated, “The publicity generated by reports of deaths in the popular press has prompted national and state medical societies to publish ‘Guidelines of Care for Liposuction’ in an effort to ward off national or state regulation”. [11] So, rather than being drawn up for patient safety, ‘Guidelines of Care’ were drawn up to ward off regulation.

THE HISTORY AND CURRENT STATE OF LIPOSUCTION – 2

“On February 17th, 1926, Charles Dujarier, a fully qualified French surgeon, operated on a young model, Mademoiselle Geoffre, who wished to improve the looks of her unbecoming legs. The operation was a disaster. Suture tension was responsible for gangrene that required amputation of the operated leg. The outcome of the lawsuit was severe for Dujarier who was required to pay 200,000 francs compensation, but even more so for plastic surgery that was practically outlawed. Two years later, Dujarier’s sentence was confirmed, but plastic surgery was cleared and considered licit on condition that the patient’s informed consent be obtained.” [12]

The original procedure used tools that scraped and cut at the fat and caused dangerous bleeding and poor results. When liposuction was introduced to the U.S. in 1982, the metabolic effects that surgically removing stores of lipid had on the body had not been thoroughly studied. Further ‘advances’ in liposuction introduced methods aimed at limiting blood loss during the procedure by pumping the body full of fluid. A long list of techniques have been ‘innovated’ by experimental surgeons for the decades. But, are these advances and increases in practice a good thing?

Recall, after being considered so dangerous that it was practically outlawed, plastic surgery was then considered licit on the condition that the patient’s informed consent be obtained. But do potential patients truly understand the outcomes before they agree to this aggressively marketed surgery? In other words, is consent truly informed? This text will explain that patients are being widely deceived, and doctors have an affirmative duty to be unequivocally clear about the dangers, yet they are not disclosing the harm.

The laws don’t limit the amount of liposuction incisions a surgeon can make. The current “Standards of Care” in the plastic surgery field, (as practiced by “top” Board Certified Plastic Surgeons), is that it’s acceptable to cut a patient and leave them bleeding out of countless incisions. The laws don’t require that surgeons explain to the patient where they will cut them or how specify or explain how much tissue they will take.

In studying the history of liposuction in depth, one can see how the field evolved without being put through rigorous tests. One can see how the lack of a National or Global Registry, (as well as the limited ability to pursue malpractice with regards to liposuction), keeps the public unaware of true statistics. Even the doctors are in the dark about the true statistics. [13] Also, once out, it’s hard to stuff the genie back in the bottle.

Recent studies done on adipose tissue highlight the fact that “We are just beginning to understand fat.” [14] Scientific studies on liposuction, (such as the one from the University of Colorado titled: ‘Fat Redistribution Following Suction Lipectomy: Defense of Body Fat and Patterns of Restoration’), [15] conclude that the fat removing procedure has negative health consequences not transparently discussed by doctors, although many adverse affects have been concluded through studies with rodents and animals for a long time. [16] 

The fat redistribution study done at UC Denver found that fat came back after it was suctioned out; it took some time, but it all returned regardless of diet and exercise. The fat did not reappear in the same place as the fat cells were removed, however, other parts of the body grew disproportionately large. [17]  It’s well accepted among animal researchers that fat removal results in fat redistribution. Indeed, animal studies suggest rapid adipose tissue (AT) re-accumulation after lipectomy is common and may even be accompanied by unfavorable changes in disease risk. [18]

The procedure has been linked to increase in visceral fat, which is linked to metabolic disturbances and increased risk for cardiovascular disease and type II diabetes. [19] Studies have also shown that liposuction may be linked in skin and other cancer. [20]

SOME COMMENTS ON THE FAT REDISTRIBUTION STUDY – 3

Dr. Felmont Eaves III, a plastic surgeon in Charlotte, N.C., and president of the American Society for Aesthetic Plastic Surgery, said the fat redistribution study was “very well done,” and the results were surprising. [21]

The finding raises questions about plastic surgery. Liposuction has been around since 1974 and is heavily advertised. Why did it take so long for anyone to do this study? “Maybe it’s because such a study is very difficult”, said Dr. Samuel Klein, director of the Center for Human Nutrition at the Washington University School of Medicine. “It takes a team of researchers, and money. Fat must be measured precisely, with scans.” [22]

Regardless, the study says, “The outcome did not depend on the surgeon. It depended on the biology of fat”. [23] Obesity researchers say they are not surprised that the women’s fat came back. The body, they say, “defends” its fat. If you lose weight, even by dieting, it comes back. [24] “It’s another chapter in the ‘You can’t fool Mother Nature’ story,” said Dr. Rudolph Leibel, an obesity researcher at Columbia University. [25]

Then there are the studies with laboratory rodents that had fat surgically removed. The fat always came back. And, like the women in the new study, the rodents got their fat back in places other than the place where it was removed. [26].

MULTIPLE NAMES FOR SUCTIONING OUT FAT – NONE PROVED SAFE – 4 

Jonathan Moreno, an ethicist at the University of Pennsylvania who has studied the field, mentioned in a New York Times article that different surgeons have different skills and different techniques. His analogy was that surgery is not like taking a drug, where one pill is just like every other. So, “instead of doing rigorous studies”, he said, “Surgeons tend to innovate, inventing their own procedures and publishing anecdotes about patients, a practice that can be misleading.” [27]

As surgeons continue to invent their own liposuction procedures, new, untested methods are continually introduced into the marketplace. [28] A dizzying list of liposuction techniques – each promising to revolutionize the industry – creates considerable confusion for the public, but none of them make an unsound procedure sound.

Fat, it seems, is so misunderstood and despised by society that doctors keep coming up with new ways to suck it out, melt it with lasers, or freeze the cells to death.

The perplexing list of names associated with liposuction includes: traditional, tumescent, dry, wet, super-wet, ultrasonic (UAL), vaser, power assisted (PAL), laser, Ultrasound, SmartLipo, SlimLipo, CoolLipo, ProLipo PLUS, LipoLite, LipoTherme, LipoControl, Lipodissolve, Liposculpture, Lipoplasty, Lipo-etching, Lunchtime Lipo, Tickle Lipo, Micro-Liposuction, Water Jet assisted, Hi-definition, Lipectomy, Lisonics, Laser Lipo Strawberry, 3D liposuction, and so on. [29]

‘The Complications of Liposuction’ (described as an important document by the American Academy of Cosmetic Surgery, and issued as an update on the ‘Guidelines of Liposuction’), states: “The advent of new techniques and technologies is not free of complications and each of these developments has been associated with a subgroup of problems that should not be overlooked.” [30]

Negative outcomes of liposuction, however, have to do with the biology of fat, not the doctor or technique; based on that foundational understanding, the complications associated with each subgroup simply presents new problems into a field that is not sound to begin with. The FDA is lax on it’s testing of liposuction devices, [31] which allows the problems to go unchecked. Please see ‘FDA approval, section 25’ for more information.

UNJUSTIFIABLE RISK – 5

An article in the Anesthesiology News, 2012, is entitled: “As Liposuction Deaths Mount, Study Exposes Cracks in Safety”. The article states that, a quarter-century after the nation’s plastic surgeons received what amounted to carte blanche to perform liposuction, a new analysis suggests that the procedure is no safer than it was back then. http://www.anesthesiologynews.com/ViewArticle.aspx?ses=ogst&d_id=1&a_id=21743 .

Death rates are reported to be as high as 1 in 5,000 patients. This compares to 1 in 100,000 deaths for plastic surgeries overall. [32] These are just the deaths that are reported, since no central database exists to accurately follow mortality or iatrogenic injuries caused by liposuction surgery, we don’t know how much worse the statistics are. [33]

The author of ‘Liposuction 101’ cites that lack of learning from mistakes, inaccurate data, and collective ignorance are all ongoing problems in the field of liposuction. He suggests the idea of a Central Registry to report complications. [34]

Suctioning fat out of the body with vacuum cannulas presents complications distinctly unlike that of any other surgical procedure and leads to long-term metabolic, cosmetic, and other complications. Whether in the media, during private consultations, or in written consents, doctors are not being clear and transparent about the far-reaching negative health impacts of liposuction. This is brazenly misleading the public and anathema to the surgeon’s creed to ‘do no harm’.

LACK OF CLEAR, INFORMED CONSENT – 6

The informed consent form put out by the American Society of Plastic Surgeons in 2009 is nine-pages long, [35] however, the form fails to explain to prospective patients the true long-term harmful disease processes or give an accurate representation of the devastating structural outcomes that may result from liposuction. The consent form has expanded since 2005, and – rather than protecting patients – this will help indemnify doctors even further against the harm they are causing.

The consent process begins in the public marketing dialogue that plastic surgeons and their boards have with the public. Patient “consent” continues into the private spoken consultations. The written consent forms do not contain full, transparent information in language that conveys risks in an appreciable way to the layperson.

According to ‘The Complications of Liposuction’, complications of liposuction includes: deep venous thrombosis and pulmonary embolism, hypothermia, lidocaine and epinephrine toxicity, cardiopulmonary arrest and fluid shifts, infection and sepsis, fat emboli, perforation of abdomen and viscera, hematoma and seroma, surface irregularities, skin excess, cutaneous hyperpigmentation, skin necrosis, changes in skin sensation, etc. [36]

Neither the Liposuction Consent Form (put out by the Society of Plastic Surgeons) nor ‘The Complications of Liposuction’ document includes the health problems that studies conclude exist long-term. Doctors ‘sugar coat’ the potential risks to sell surgery to trusting patients who have no real idea what they might be getting into. For example, in the University of Colorado study, every patient experienced adipose re-accumulation in untreated areas, and yet this assured detrimental effect is not cleared with each candidate.

True transparency would require full health disclaimers be given in clear layman’s terms.

It looks to me like the 2009 consent form put out by the American Society of Plastic Surgeons has five more categories than their 2005 consent form did. Therefore, it seems to me that either liposuction is getting more dangerous, or the consent form is attempting to protect more doctors against the ills that are resultant from it.

COMPETING DOCTORS INCREASE PUBLIC CONFUSION – 7

A push-pull within sub-groups of the medical profession complicates the issues even more: Board certified surgeons fault dermatologists (who don’t have hospital privileges) for using local anesthesia and not being plastic surgeons. Dermatologists fault board certified plastic surgeons for performing too much toxic, aggressive surgery at once via general anesthesia. [37] This internal finger pointing implies that the side effects are related to the doctor’s training and technique, when in fact, the biology of fat is at fault. [38] Not to be overlooked is also the invasive technique and guesswork that goes into liposuction. 

In sum, several competitive groups of doctors who benefit handsomely from the surgery have convinced the public that – contrary to its poor track record and scientific studies proving otherwise – liposuction is safe. Of course, this does not make it so. The idea that doctors (board certified plastic surgeons or not) are above the fray should be earnestly questioned in order to prevent further widespread iatrogenic (medically induced) harm.

BOARD CERTIFIED PLASTIC SURGEONS CREATE UNDUE HARM – 8

The ABPS (American Board of Plastic Surgery) is self- described as the ‘gold standard for plastic surgery certification’. [39]

Something that is not well publicized is that ABPS board certified plastic surgeons may have a lifetime pass; that means that if they were certified before 1995, their certification is ‘valid indefinitely’ [40] and continuing education is not required. If initially certified after 1995, the ABPS only requires doctors to get re-certified every ten years. [41] This doesn’t seem to be near enough continuing education to keep up with the field of plastic surgery.

A little background: Tumescent liposuction was invented and developed in 1985. The word “tumescent” means swollen and firm. By injecting a large volume of very dilute lidocaine (local anesthetic) and epinephrine (capillary constrictor) into subcutaneous fat, the targeted tissue becomes swollen and firm, or tumescent. Tumescent liposuction uses unprecedented large doses of lidocaine and epinephrine. [42] When general anesthesia is added to the tumescent liposuction technique there are increased complications. [43]

The book ‘Liposuction 101’ explains that board certified plastic surgeons often put patients under general anesthesia and perform concomitant surgeries in the same operation. Concomitant procedures radically intensify liposuction risk by increasing surgical time and trauma on the body, and by combining lidocaine on top of general anesthesia. [44] Lidocaine toxicity, fluid shifts, and fat emboli have often been attributed as the cause of death in liposuction surgeries. [45]

Putting a patient under general anesthesia may give surgeons the illusion that they can ‘safely’ remove more fat at one time because the unconscious patient doesn’t feel the pain during surgery, however, hazards include but are not limited to: cosmetic and health catastrophes through over-resection, organ perforation, trauma, shock, lidocaine or anesthetic toxicity, and third-space swelling. [46] Thus, contrary to popular belief, ABPS board certified doctors are in the position to pose significant threats via liposuction.

While under general anesthesia, patients cannot provide feedback to a surgeon who might cut through gristle and muscle, nor can they challenge a doctor who operates beyond the realm of consent. Another alarming danger is that, while the patient is under anesthesia, some surgeons treat loose skin (ptosis) like excess fat and suction out essential tissue.

On www.liposuctionruinedmylife.com, ‘Tom’ from Australia provides details and MRI photos to illustrate how surgeons vacuumed out part of his chest muscles. He says, “…I faded back under sedation and awoke again with my right arm above my head and could see that Dr. Massacre was again working on me. I could see the tissue on my right side from my shoulder to my chest being stripped away… I immediately worried about what was happening as this is an area I had purposely been building up with weight training – I knew there was minimal to zero fat on this area so knew that what was being stripped away had to be muscle and connective tissue. Worse still, even though sedated, I knew full well that I had never consented to any work on my shoulders, or my arms. [47]

UNSOUND PROCEDURE MARKETED BY PLASTIC SURGERY BOARDS – 9

The problem with liposuction is much larger an issue than whether doctors are certified by the ABPS, the ASAPS, or not. Recall, the problem with liposuction is rooted in the biology of fat. [48] There are not long-term studies proving that liposuction is physiologically sound. There are, however, studies (on both rodents and humans) that show that liposuction negatively affects metabolism, creates an increase in visceral fat, [49] long-term fat mobilization,[50] metabolic syndrome, [51] and an increase in insulin resistance [52] (possibly leading to type 2 diabetes). Liposuction, a non-curative surgery, also causes fat to deposit in untreated areas, and poses serious risks of structural damage.

PROCEDURE – 10

Dr. Rosemary Leonard (Britain’s best known GP, and a distinguished Member of the British Empire honoree) explains that “liposuction is not a gentle procedure… a large, hallow needle, which is attached to a powerful suction machine, is inserted in turn through several small cuts in the skin. It is passed into pockets of fat, where it is moved around with considerable force”. [53]

In the article for the NY Times (The Belly Finds What the Thighs Lose), Dr. Samuel Klein posits that ‘Liposuction violently destroys the fishnet structure under the skin where fat cells live.’ [54]

Liposuction is particularly dangerous because the surgery requires doctors to suction out fat by repeatedly jabbing a suctioning device deep into a person’s body which increases the risk of accidentally perforating vital organs”. [55]

According to a high profile plastic surgeon, in Orange County, “Fat is yellow rather than red, because it has a low density of blood vessels. The blood vessels are necessary to bring the healing nutrients and cells to a surgical wound. And, a lower density of blood vessels, will result in slower healing and increased susceptibility to complications.” [56] In sum, since fat isn’t vascularized, recovery rates can be lengthy for liposuction surgery.

The process may go something like this:

Heavily misled by a heavy marketing campaign that portrays liposuction as a safe, viable solution for ‘diet and exercise resistant contour irregularity problems’, a person (about 90% women) seeks out a doctor for a consultation. Anyone with a medical degree can perform the surgery. If a doctor deems the patient a candidate, the exam continues:

A doctor may examine the body by “pinching the tissue between their fingers” to estimate of how much essential subcutaneous fat to remove. The estimate is not always shared in advance with the patient. Since body composition is complex, it would seem that MRI scans would be a minimum requirement, but instead, doctors generally ‘pinch and guess’. [57] Then, a patient is given a non-transparent consent form to sign, and payment is collected. Since liposuction is an expensive, elective procedure, people pay with cash or credit, often financing their surgery. [58]

At some point before surgery, doctors may likely take ‘before’ photos with the patient either in a meager garment, (such as paper thong underwear), or fully naked. The photos seem cropped and lit in a way to show off pre-surgical flaws.

While standing there naked for the ‘exam’, the patient will be scrutinized by the doctor, who may suggest surgeries for contour issues that the patient hasn’t even inquired about. A related example is that a woman needing breast reconstruction may be told that adding on a little liposuction will be no big deal, as she will be under anesthesia anyway.

If there have been adequate consultations, it would seem that the details would have been meticulously worked out well in advance, since the surgery permanently alters the patient’s body, however, moments before surgery, the doctors take an ink pen and draw on ‘target’ areas of the patients body. Moments before surgery would not seem to be a good time to expect negotiations to be made on a possibly nervous pre-surgical patient.

There is an unrealistic burden placed on the patient to make decisions regarding their surgeries even though vital information is withheld from them. Liposuction is considered ‘elective’ which erroneously places the responsibility on the patients, (who are not surgical experts themselves), and takes the accountability off of the doctor, no matter how ludicrous and physiologically unsound the surgery performed is.

Doctors take ‘after’ photos – sometimes on the three-month checkup. At this point, many of the external bruises have faded, and the person’s body does not yet show signs of altered fat depositing patterns created by the liposuction. Doctors may post these photos on their website to show a ‘good outcome’ in order to advertise and entice other people to come in and pay thousands of dollars for surgery that hasn’t been proved to be safe or beneficial to one’s long-term health — under any name.

If the surgery does not initially produce a ‘good visual outcome’, it’s unlikely that doctors would post ‘after’ photos on their website or show them to potential patients. Some bad ‘after’ photos can be viewed, however, because desperate patients post them online. Doctors may recommend additional surgeries (such as more liposuction, fat grating, skin reduction) to try to correct the bodies they have disfigured. [59] In most cases, the patient is expected to pay out-of-pocket for the supplemental surgery.

Fat grafting requires additional liposuction in order to ‘harvest’ fat for the graph. Fat does not come with it’s own blood supply, so only a percentage of fat transferred will be assimilated. Fat grafting is shrouded in a stigma of variable results, and of course, more surgical risk. [60] Skin excision is of course an invasive, risky, and expensive surgery.

Regardless of the immediate visual outcome, recall that the UC Denver study concluded that the post-liposuction body will begin to store visceral fat in order to try to re-achieve homeostasis. So, what might initially look to be a visual improvement actually leads to long-term health consequences: a regrowth of fat in weird places; fat mobilization; metabolic syndrome; increased insulin resistance; and more, yet doctors regularly trivialize, ignore, or refute scientific studies in public forums and private consultations. This leaves the consumer with an incomplete, inaccurate understanding of liposuction.

Doctors who perform this physiologically unsound surgery take an active part in creating long-term harm. Is this how we (and other doctors in reputable fields of medicine) want doctors to lower the standards for the profession as a whole?

THE MISNOMER OF ‘NON-ELASTIC’ SKIN – 11

When doctors suction out too much fat, serious outcomes are likely. The skin may adhere to the underlying structure, [61] or the client may be left with loose sacks of hanging skin. [62] The doctors may refer to this as ‘non elastic’ skin, and say that the skin has to ‘snap back’. But skin doesn’t snap back after emptied of its fat stores. [63]

The natural weight loss community is proof that skin often cannot keep up with the changes the body has been through; skin may not shrink back to the same size as the body, leaving unsightly and uncomfortable excess skin behind. This distressing outcome of fat loss is why people look into having serious body lift/skin excision surgeries after losing weight in a much slower way through diet and exercise. [64]

If, during consultation, a doctor feels that skin on their patient isn’t ‘elastic’, then liposuction is clearly contra-indicated and should not be performed. If, however, a doctor feels that skin on their patient is elastic, yet they vacuum out fat causing the skin to be loose, that is iatrogenic harm, caused by negligent surgery. Either way, referring to ‘non-elastic skin’ as the problem lets doctors off the hook. If all of the subcutaneous fat stores are removed in an area, the skin painfully adheres to the underlying muscle fascia. [65]

A doctor, who creates the need for skin reduction surgeries or suctions out all of the fat stores in a patient who walked into their office as a healthy person before liposuction, should be held accountable. Ethics, common sense, and sound medical judgment should serve as guideposts for doctors to understand when to abstain from surgery.

WHAT IS FAT?  –  12

Fat serves important, essential biological purposes; it stores excess calories in a safe way so you can mobilize the fat stores when you’re hungry; it pads, protects, and insulates the body; helps to transport vitamins; and releases hormones that control metabolism. Fat is ¾ fat — the rest is collagen fibers that hold in place veins, nerves, stem and immune cells.

  • Subcutaneous fat is close to the surface of the body. This is the fat that can be pinched in your fingers; it poses less of a health hazard than visceral fat.
  • Visceral fat is the internal fatty tissue that wraps itself around the heart, liver, kidneys and pancreas, and streaks through muscles and most of its actions are harmful to the body. Dr. David Haslam of the National Obesity Forum says, “Visceral fat is known to cause inflammation in the colon and artery walls, and is a major cause of heart disease, diabetes and some cancer” Diet and exercise can reduce visceral fat; liposuction does not reduce visceral fat, but may increase it. [66]

Unlike subcutaneous fat, visceral fat reduces the body’s sensitivity to insulin, the hormone responsible for maintaining normal blood-sugar levels. It boosts levels of triglycerides and low-density lipoprotein (LDL); it also lowers levels of cardio-protective high-density lipoprotein (HDL) cholesterol. Liposuction reduces subcutaneous fat, but diet reduces visceral fat.” [67]  Studies show that liposuction creates more visceral fat at least a year or more after the procedure.

When liposuction was introduced to the U.S. circa 1982, the effects that surgically removing fat had on the body had not been comprehensively studied. Scientific studies over the past decades, however, have concluded many serious long-term results. Aaron Cypess, PhD., Harvard Med School states: “We are just beginning to understand fat.” [68]

Liposuction can harm healthy people, and it does not make an obese person healthier. Fat is an important endocrine organ. The removal of benign subcutaneous fat stores may make you worse off in terms of metabolic health. [69] In sum, fat (not obesity, but fat) in biological terms is useful, essential, and complex, the fullness of which we don’t understand yet, but liposuction is not a cure, and it is dangerous. Why are surgeons removing this essential tissue?

FAT DISTRIBUTION – 13

In 2008, Dr. Rallie McAllister, MPH wrote: “Excess body fat is a health hazard, but the distribution of that fat may be the best predictor of future health risks. The results of a study published in the American Journal of Clinical Nutrition indicate that how much fat a person has is less important than the location of fat when it comes to determining risk for cardiovascular disease. For the study, researchers evaluated body fat distribution in nearly 400 adults between the ages of 47 and 86. They found that the amount of non-subcutaneous fat – the fat deposited around organs and between muscles – was directly correlated to the amount of hard, calcified plaque present in the body. Calcified plaque is associated with the development of atherosclerosis, a condition that increases the risk of heart disease. Among Americans, heart disease is the leading cause of death.” [70]

Liposuction procedures are aggressively marketed towards women who have “slight contour issues” and stable weight through healthy diet and exercise. Now, if we consider that a woman is at her stable weight, doesn’t it make sense that her body has achieved equilibrium? And if fat were then removed to “contour’” her body, would her body then not naturally attempt to return to it’s equilibrium?

The UC Denver study concluded that once fat cells were removed in one area, the fat cell size increases disproportionately in other areas. [71] In other words, removing fat from the abdomen has caused women to regain, significantly, fat in other areas, like arms, breasts, thighs, buttocks, etc. Beyond the unsettling appearance problems this creates, we must also consider the re-distribution in terms of dangerous visceral fat.

The typical female pattern of accumulating fat in the hips and thighs may not simply be benign with respect to disease risk, but may in fact protect against cardiovascular disease risk. Removing a portion of this important fat depot (via liposuction) could increase disease risk. [72]

It would seem that surgical experts would be required to comprehend fat distribution in great depth and unequivocally communicate the grave resulting harm to their patients. Creating compensatory fat regrowth in non-treated areas is a non-curative, harmful result cosmetically as well as in terms of the physical and emotional health of the patient.

THE HARMFUL EFFECTS OF VISCERAL FAT – 14

Visceral fat, the fat increased as a result of liposuction surgery, is the internal fatty tissue that wraps itself around the heart, liver, kidneys and pancreas, and streaks through muscles. Visceral fat behaves differently than the largely benign fat that lies just below the skin (the sort you can pinch). Visceral fat is dangerously toxic.

Recall, Dr. David Haslam, clinical director of the National Obesity Forum says, “Visceral fat may seem to be an inert lump of lard, but it’s actually highly active and constantly pumping poisons into the bloodstream. Visceral fat is known to cause inflammation in the colon and artery walls, and is a major cause of heart disease, diabetes and some cancer.” [73] Research suggests that visceral fat affects mood by increasing production of the stress hormone, cortisol, and reducing levels of feel-good endorphins. Along with killing you, visceral fat, it seems, can make you feel low.” [74]

To be clear: Liposuction causes a long-term increase in visceral fat, which increases the risk of developing diseases, such as Type 2 diabetes, heart disease, non-alcoholic fatty liver disease, high blood pressure, cancer, stroke and Alzheimer’s disease. Researchers have identified a host of chemicals that link visceral fat to a surprisingly wide variety of diseases.

THIRD SPACE SWELLING – 15

Third spacing is the physiological concept that body fluids may collect in a “third” body compartment that isn’t normally perfused with fluids. Third-space fluid shift is the mobilization of body fluid to a non-contributory space rendering it unavailable to the circulatory system. Third spacing swelling can cause many life-threatening complications including hypovolemic shock and dehydration. [75] Needless to say, suctioning out liters of fat, blood, and fluid from a human body is risky and traumatizing. 

LONG-TERM DAMAGE – 16

Liposuction causes negative affects with regards to visceral fat, hormones, lymphatic system, fat mobilization, metabolism, disturbing (and often disfiguring) weight re-distribution, ongoing pain, numbness, scarring, hard fibrous adhesions, loose baggy skin, skin adherence, damage to underlying structure, metabolic syndrome, and an increase in insulin resistance (which can lead to type 2 diabetes) and so on.

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0108717. According to this study published in 2014: Eight weeks post lipectomy, animals had significant higher body and liver weights, weight gain, liver to body weight ratio, and revealed significant higher hepatic triacylglycerol and serum insulin level. Here are some more specifics:

VISCERAL FAT

The study done at UC Denver in 2011 concluded that after liposuction, fat re-deposits in unhealthy ways, creating more visceral fat. In online blogs, desperate patients describe the way fat re-deposits in disturbing, disfiguring ways after liposuction. What patients likely don’t realize is that their fat re-distribution has affected the visceral fat deposits. [76] 

FAT EMBOLUS SYNDROME

Hyperlipidemia is the presence of elevated or abnormal levels of lipids and/or lipoproteins in the blood, and is a major risk factor for cardiovascular disease. Fat embolus syndrome (FES) is a disorder caused by fat particles that enter the circulatory system and is characterized by respiratory, hematological, neurological, and skin symptoms. [77] Liposuction causes mechanical trauma to fat deposits, which leads to systematic fat mobilization. Studies conclude that FES occurs after liposuction. One clinical study done on rats published in the ‘Aesthetic Plastic Surgery Journal’ in 2009 revealed that: “Although there were no fat particles in the blood before liposuction, blood specimens obtained following the procedures and in the long-term had fat particles.” [78]

INCREASE IN INSULIN RESISTANCE

Insulin resistance (IR) is a physiological condition in which cells fail to respond to the normal actions of the hormone insulin. Insulin resistance can contribute to hypoglycemia, and contribute Type 2 Diabetes. [79] A study done in Brazil in 2013 concluded that “Insulin resistance shows significant increase in liposuction, and it is correlated to the volume of aspirated fat”. In other words, insulin resistance increased with liposuction as the volume of aspirated fat increased: over 1500 g there was an increase of 123% and less than 1500 g there was an increase of 53 % from the baseline data. [80]

METABOLIC SYNDROME AND DIABETES 

Metabolic syndrome is the name for a group of risk factors that occur together and raises your risk for coronary artery disease, stroke, and type II diabetes. [81]The American Journal of Physiology published an article that concluded that hamsters that underwent lipectomy developed a metabolic syndrome with significant hypertriglyceridemia, relative increase in intra-abdominal fat, and insulin resistance. “We propose that subcutaneous adipose tissue (SQAT), via disposal and storage of excess ingested energy, acts as a metabolic sink and protects against the metabolic syndrome of obesity.” [82]

HORMONAL ISSUES 

Liposuction may cause hormonal imbalance. For women, one way in which estrogen is synthesized in the body is through fat cells. Removing these healthy stores of fat can confuse and harm the body.[83] If you take away estrogen-dominant fat areas, such as inner thighs or love handles, you are potentially taking away your bank of extra estrogen storage needed during menopause as well as creating an unpredictable outcome of your body shape. In our studies, we found woman of all ages reporting various problems with their menses after liposuction and hormone levels in the long-term after lipectomy.

Fat communicates with the brain and immune system. Leptin, “the saturation hormone,” fat’s most powerful messenger, was discovered in1995 – decades after liposuction had been in full swing. Leptin is tied closely to regulating energy intake and expenditure including appetite, metabolism and hunger. So when you lose a lot of weight quickly, via liposuction or serious calorie restriction, your leptin levels plummet. Subsequently, you get hungrier, your thyroid decreases output and your metabolic rate drops. This can cause slow one’s metabolic rate way down, and cause one to gain more weight.[84]

When women lose fat in the hips, buttocks and thighs, (areas of high estrogen concentration), they gain it disproportionately in the belly. Visceral fat in the belly is the toxic type of fat discussed earlier in this paper. Even small changes in hormone distribution can have dramatically different effects on our fat.  Pg. 140, The Secret Life of Fat

INFERTILITY 

A woman’s BMI between 19 and 25 is best for fertility. Liposuction has caused cessation of menstruation and impeded or ended fertility for even young, healthy women.

HYPERTROPHY AND HYPERPLASIA 

Liposuction causes cells in untreated areas to grow larger (hypertrophy), and / or the number of cells to increase (hyperplasia). As mentioned in another article, smaller cells are more efficient than larger cells, and either visceral fat or subcutaneous fat growing in untreated parts of the body can be unsightly, and unhealthy.

In just a quick, initial search using “lipectomy hyperplasia” – on Google Scholar the following studies were found:

1) Adipose Tissue Regeneration Following Liposuction: This one refers to adipose mass and number being restored 7 months after removal. Many plastic surgeons assert that only an increased mass occurs, but this study proves otherwise. [85]

2) Photoperiod-dependent fat pad mass and cellularity changes after partial lipectomy in Siberian hamsters: In LDs, lipectomized hamsters showed compensatory mass increases in retroperitoneal WAT (RWAT) due to hyperplasia. IWAT mass also was increased by approximately 40% in LD-housed EWATx hamsters because of non-significant increases in adipocyte size and number at weeks 6 and 12, respectively. Hyperplasia = increased number, not size. [86]

3) The regulation of total body fat: lessons learned from lipectomy studies: This article suggests that the increased fat is mostly due to mass increase, and not number. This write-up challenges the assertion of plastic surgeons in their effort to blame patients eating habits on post-lipo weight gain. [87]

 

THE CLIENT EXPERIENCE – 17

People who have undergone liposuction report the following issues:

  • Major (negative) body contour changes;
  • Disturbing regrowth of fat in weird places;
  • Disturbing areas of loose skin;
  • Painful adhesion of tissue to the underlying structure
  • Claims of surgeons exceeding consent;
  • Long-lasting and chronic pain;
  • Loss of health;
  • Ongoing numbness;
  • Ongoing problems with hematomas and seromas;
  • Ongoing problems with swelling;
  • Ongoing sciatic and other nerve pain
  • Significant hormonal issues, including cessation of menses and infertility
  • Thyroid problems
  • Increased Vascularity
  • Cessation of menses, Infertility
  • Lumpy, bumpy, hard and fibrous adhesions and/or striated tissue;
  • Inability to keep weight regulated post surgery, even with good diet and exercise;
  • Feeling of anger, depression, and despair over having their bodies dis-figured;
  • Feelings of betrayal by their doctors
  • Loss of confidence
  • Loss of feminine curves
  • Loss of social life and strained relationships due to the surgery

 

There are thousands of these complaints on websites such as www.RealSelf.com, www.MakeMeHeal.com, and so on. What is more disturbing are the absolutely despairing posts from people who cry out for help after their surgeries, and then the trail of their posts stops. The reader is left to assume the worse. Here are a few examples:

  1. http://www.realself.com/review/11-weeks-after-liposuction-and-still-extreme-pain. A woman in Philadelphia calls out for help nearly 3 months after her procedures. She says: “I am still in extreme pain for majority of the time. I am unable to work or take care of myself. I am becoming psychologically worn out from this debilitation. I was told that I would miss 3-4 days of work. What is wrong, and who do I go to for help?”

 

  1. http://www.realself.com/user/20087 A single 27-year-old in D.C. cries out that she has considered suicide due to the devastating effects of liposuction. Her buttock was operated on against consent, her body dented, disfigured, and she has no butt. “I am so deformed and this has taken over my life… I cry all the time and have thought of suicide because I can not live with this pain anymore.”

 

  1. http://www.realself.com/review/give-anything-undo-lipsuction A 21 year-old in Las Vegas posts several times desperately looking for help. “A year after the procedure I kept trying to tell myself it was better than it has been, but I just can’t lie to myself anymore.  At times it makes me not want to live anymore, please think twice before lipo.  I just want it fixed but I have no idea how”.

Although there are many self-reported, severe complications, there is no official medical database to follow or record these needless health disasters. Patient complaints are often whitewashed and they are made to feel the bad result was somehow a result of their own ‘unrealistic expectations’, rather than the doctor’s negligent judgment along with the inevitably bad outcomes from suctioning fat out of the body with a vacuum.

As mentioned, studies show the body defends its fat, and fat then grows in areas that were not treated. Short-term visual results are not indicative of long-term results. Liposuction is marketed to people who are already observing healthy diet and exercise habits, and are at their best weight and fitness, but the patients regrow fat in other areas of the body even as they maintain their healthy life-style habits. The same fat distribution patterns were documented with rats in laboratory studies. So, instead of clearly warning women of this known affect before obtaining their money and uninformed consent, women are blamed for having it happen to them. Some women report going on dangerous diets after liposuction to try to keep fat from growing in uncomfortable, unattractive ways.

There’s an assumption in the public that people who seek out liposuction are vain, ignorant, or lazy people who ‘deserve what they get’. However, most everyone can identify with some feeling of not being satisfied with his or her body, or can understand why a person may consider a breast reduction or breast reconstruction after cancer vital to their well-being. There are many reasons why a person’s body might store fat in what might be seen as an undesirable way: some have a genetic propensity to uneven fat pads, fat deposits accumulates due to childbirth, disability, gynecomastia in men. People in the weight loss community hope to surgically improve the look and feel of body flab after diet and exercise.

Patients trust the extensive liposuction marketing campaign by doctors and surgical boards who market themselves as “experts” and “the gold standard”. Publicly and privately, these doctors describe liposuction as being a safe solution for ‘stubborn diet and exercise resistant contour areas’ and convince patients it is routine and “no big deal”.

The clients are hopeful, encouraged by doctors to believe in a good outcome, but they are not equipped with adequate information that separates truth from hype because doctors and surgical boards withhold the information patients need to make an informed choice. 

After the doctors perform the unsound procedure, it is the patient that is subsequently blamed for the bad to horrific results. “They asked for it.” 

REALSELF.COM – MISLEADING TO POTENTIAL PATIENTS – 18

When many questions about liposuction, breast reduction, and so on are entered into some of the top Internet Search Engines such as Google, one of the main websites that comes up is RealSelf.com. RealSelf proclaims to reach 3.5 million consumers. [88]

Real Self is an online arena that serves as an advertisement forum for plastic surgery. Real Self describes one of their features: “Board-certified doctors and experienced specialists answer questions posted by members.” [89] On their ‘Q and A’ forum, 5,000 doctors answer questions about plastic and reconstructive surgeries. Since participating doctors have a financial interest in promoting themselves and the procedures, this poses an innate ethical conflict of interest. Doctors who answer the most questions have the most exposure, so the doctors are using the site as self-promotion, and trying to win over customers. One would think that doctors who warn too directly of dangers would not get the business, because rational people don’t want to risk their life for surgery.

A woman who appears to be slender posted several photos of her body, and inquired about getting liposuction for her abdomen, waist, and flanks. She explained that two plastic surgeons in private consult had recommended that she not have liposuction. They both suggested forgoing the procedure and, instead, intensify her exercise routines. Her diet, she explained, is already strict.

Here is her question, with photos: http://www.realself.com/question/good-candidate-for-u-l-abdominal-waist-and-flank-liposuction

But some of the doctors on RealSelf were quick to point out that she was a ‘good candidate’ for liposuction. One of the top rated doctors stated, “Yes, your physique is good, but I could still remove 2 liters or so”. The photos show(ed) a slim woman, yet the doctor didn’t mention concern for the fact that her body might biologically need those critical two liters of fat to perform the necessary functions that fat provides. Another doctor encouraged her to find a surgeon that can ‘see things from her point of view.’ Recall, her diet is already strict, so if she further restricts calories and nutrients, her health will suffer, but if she doesn’t, the essential fat will regrow in other places. [90]

If this woman listens to these doctors and moves forward with liposuction, it may be the end of her healthy body and therefore, of her well being. If obvious over-resection is apparent right away, she may then opt to get fat grafting or a risky surgery to remove ‘excess skin’ – a problem she currently does not have. Obvious over-resection, or organ and muscle perforation may be evident immediately. Additionally, she may experience disturbing fat regrowth a year of more later. Her risk may be increased for metabolic syndrome, type II diabetes, and other known resultant long-term complications of liposuction, without ever understanding what caused these problems.

In one such typical answer after another on the site, the doctors continue to hype liposuction as a good remedy for ‘contour irregularities’, but are not transparent about the real risks. If prospective patients without medical degrees of their own (but with a learned trust in doctors,) review the Q & A forum, they can be indoctrinated into believing that suctioning out fat is a good idea, sanctioned by the top-rated doctors, who are sanctioned by medical boards. Prospective patients don’t search extensively for scientific studies because they believe the doctors, and may not even be aware that such studies exist.

Pando Daily states: “RealSelf makes money with a subscription ad product for the doctors, not unlike the Zillow model for realtors. If you hold a four or five-star rating and are in good standing with the community, you can buy a presence in search results.” [91] According to the Puget Sound business journal, RealSelf.com made 2.4 million dollars in revenue in 2011. [92] Advertising plastic surgery is very big business as evidenced by the impact that surgery has on the stock exchange. [93] 

RealSelf.com also describes their site as “a community of people helping each other make good decisions.” [94] There are many sad stories to be found on the site, which can provide a useful education for anyone who takes the time to read extensively, but unfortunately, prospective patients are more inclined to be hopeful and to read the seemingly positive reviews. Likewise, prospective patients will often pay more heed to the doctor’s comments, even though the doctors are not being transparent about all of the risks or the negative long-term affects. The doctors may not indeed even truly understand the issues.

Some of the ‘thumbs up’ reviews change their tone when followed in the long-term. It’s also not possible to tell if some of the short, glowing reviews of ‘the perfect surgery, and the perfect result’ are reviews paid for by the doctors. On RealSelf.com, women without surgical backgrounds are encouraging other women to get risky plastic surgery before their own results are even experienced; it’s a very dangerous group mentality.

  1. STUDY, 2012 – 19

One of the doctors on Real Self conducted a study in 2012 that concluded “fat cells neither return to treated areas nor get redistributed to untreated areas of the body after liposuction.” [95] His conclusions are in opposition to the study done by scientists at UC Denver, (and other studies). His conclusions also refute countless online cries from liposuction patients that point to the fact that fat distribution patterns change after the procedure, and other areas grow larger as a result.

Dr. Raffi Gurunluoglu, of the University of Colorado Health Sciences Center, challenges his analytics noting that “the photographic documentation in these patients was not originally designed to measure changes in shoulder width, mid-humeral width, and upper abdominal width, and this weakens the conclusions regarding fat redistribution.” Gurunluoglu also notes that further research needs to be conducted “to determine the effects of liposuction on the regrowth of fat, as well as on anatomic patterns of fat redistribution.” [96]

 

SURGICAL GUESSWORK – 20

Figuring out the gross composition of the human body (including how much fat the body has, and where the fat is located) is a complex process according to ‘Exercise Physiology’ by McArdle, Katch & Katch. “In a living organism, it isn’t possible to differentiate between essential and non-essential fat.” [97]

Doctors do not typically precisely measure fat with scans before and after liposuction. Doctors explain that pinching the fat and skin between their fingers before they stick cannulas into the body and ‘guess’ how much tissue to vacuum out, is good enough. Here is a link to in which they talk about their experience in pinching fat and skin between their thumb and fingers: http://www.realself.com/question/body-fat-accurately-concretely-measured-before-suctioning-through-liposuction

Even if doctors’ use calipers rather than their fingers, it’s a very crude way to guess at the complex fat makeup of the body. The Mayo Clinic and Livestrong.com have pointed out that calipers may not be very accurate. On a person with loose skin, even more so, the calipers can pinch skin and measure it as fat.

Body Mass Index – which is determined by this equation: person’s weight divided by his or her height squared – can be grossly misleading because muscle is more dense than fat. According to the ‘Exercise and Physiology’ text, goal weight should be based on body composition, not stature. [98] Body Mass Index and weight can be misleading, and are not truly accurate assessments of how much lean versus fat mass a body has. [99]

When performing liposuction, doctors may suction out essential tissue, because loose skin can feel soft and similar to fat, yet recall: these doctors state that because they are educated and experienced, their ‘guesses’ are good enough. In the Discovery Channel documentary, “Cosmetic Surgery Gone Wrong”, a physician described increases in corrective surgeries in her practice. She also states that in some ‘weekend certification courses’, physicians practice on a tomato, which of course is much different than working on real patients. [100]

Doctors can’t be sure what percent of white fat cells, brown fat cells, blood, or other essential connective tissues are suctioned out, however, it’s been proved that brown adipose tissue lipectomy leads to increased fat deposition in carcass fat. [101] The brown fat cells, recall, are the ones that assist with metabolism; removing them is not positive for the long-term health of the patient. After lipectomy, (liposuction), the tissue is commonly disposed of as “biohazard” rather than being sent to a laboratory for analysis.

Also, liposuction removes fat cells from certain parts of the body, causing the remaining fat cells to increase in size as the body “defends it’s fat”. Smaller cells do a better job biologically than larger cells, so doctors are harming people’s health by performing this procedure. [102]

The pinch and guess “technique” is so ridiculous. It indicates a primitive understanding of fat (skin and fat). And if they don’t understand it why are they allowed to do it?

VIOLATED CONSENT – 21

A thorough search online regarding claims revealed a PUB Med report: “Two-thirds of the liposuction malpractice claims, (67 percent), arose from informed consent or breach-of-contract issues, far higher than the 26 percent aggregate claims norm.” [103] 

A signature on a consent form does not constitute true informed consent since the information given to patients regarding liposuction is not complete, and the information that is there is not communicated in a way that most lay people can appreciate. Doctors are dismissive of the traumatic and long-term consequences of liposuction, and do not convey to their patients the true ramifications of the surgery.

Charts are not generally drawn up in advance, as doctors prefer not to be pinned down to where they can operate. Doctors operate on parts of the body against the patients consent while the patient is unconscious under general anesthesia. Here are a few examples:

  1. http://www.realself.com/review/marietta-ga-liposuction-bad-lipo-result “I consulted for ab/flank lipo and was 10 lbs. over my ideal weight. He recommended a little inner/outer thigh since it wouldn’t be much more and it would “smooth out” the silhouette. I regret the day I ever met him. He performed lipo in an area I did not consent to and ruined my thighs and butt. He gave me a DOUBLE GLUTEAL fold under both cheeks, which is the result of overaggressive lipo.”
  1. http://www.realself.com/user/318375 “…Plastic surgeons should never touch an area not agreed upon. I was lipoed in 3 areas that I didn’t agree upon and now have 3 problem areas. My doctor acted as if she was doing me a favor…no she didn’t, she caused 3 problem areas.” 

THE ZONES OF ADHERENCE – 22

Doctors sometimes suction tissue out of the non-violate ‘Zones of Adherence’, areas of the body where there is minimal or no deep fat layer. In these areas, the superficial layer and its overlying dermis are thin, making them even more susceptible to contour deformities than other areas of the body. [104] In other words, there is little to no fat in these areas, and surgeons should not suction tissue out.

These zones include:

  1. The gluteal crease (crease under the buttocks)
  2. Lateral gluteal depression (on the side of the body near the hipbone)
  3. Middle medial thigh (mid inner thigh)
  4. Inferolateral illiotibial tract (about midway down the side of the thigh)
  5. Distal posterior thigh (the lower area on the side of the thigh) [105]

 

Operating on the non-violate infragluteal crease often causes irreversible harm to the functional structure of a person’s buttock. In Lipo 101, Dr. Klein explains, “If you remove too much fat, it will result in pain when the patient sits on a hard surface because of insufficient fat overlying the ischial tuberosity.” [106] In addition to affecting one’s ability to sit, damage to the buttock via liposuction may damage gluteal ligaments, which is irreversibly painful, and will interfere with a person’s ability to walk or move normally.

SURGEONS CODE OF ETHICS – 23

The medical boards give credence to doctors who are not required to stay current in their profession. Also, doctors are misleading patients without full disclosure of facts; the doctors do not tell patients that, regardless of the immediate cosmetic outcome, liposuction is fraught with guesswork, and causes negative long-term harm.

According to the American Society of Plastic Surgeons Code of Ethics, (under the auspices of the American Medical Association), doctors have an affirmative duty “to provide the public with information about the scientific progress in plastic and reconstructive surgery”, to “render services to humanity with full respect for human dignity”, and to “merit the confidence of patients entrusted to their care, rendering to each a full measure of service and devotion.” [107]

FDA APPROVAL – 24

Murad Alam, MD, chief of cutaneous and aesthetic surgery at Northwestern University Feinberg School of Medicine said, “Several obstacles prevent conducting large-scale research trials on cosmetic procedures and devices. Because the FDA’s approval mechanism for devices is less rigorous than for drugs, the agency doesn’t compel pharmaceutical companies to do large trials. Thus, companies may test a device on as few as 50 or 100 patients. As soon as a mechanism gets approval, companies aren’t motivated to do more testing or to compare one procedure to another.” [108] 

FDA approval is not even required for liposuction equipment although some companies do pursue that approval. The FDA “approved” some of the PAL MICROAIRE cannulas (and equipment) on a 501(k) submission, while others were completely exempt. I believe the 501(k) means that it got a 90-day approval letter and was compared to a predicate. [109]

The Complications of Liposuction cites that “Care should be taken when using power assisted cannulas and even ultrasonic or laser technologies since the tissue resistance changes making easier the penetration of undesired structures.” [110] In other words, when a suctioning device is inserted into the body, it can penetrate organs, muscles, nerves, etc.

The FDA points out that the short-term effects i.e., free fat entering the blood stream and long-term ultrasonic effects on tissues are not known. [111]

This being so, neither the FDA nor doctors warn the public of the unreasonable risks they’re consenting to. It can take prospective patients great effort to find the scientific studies they may not even be aware of. So, who’s looking out for the patients well being?

OVER-RESECTION – 25

‘The Complications of Liposuction’, journal articles such as ‘The Zones of Adherence’ and other medical texts warn about the issue of over-resection via liposuction. Distressing patient reports detail what it’s like to live with some of these effects.

Producing a loose, hanging buttock – on even the youngest women – is discussed in both the professional and personal arenas. Over resection not only looks bad, but also can be so severe as to cause skin to painfully adhere to the underlying bone and muscle. The lower buttock can be particularly problematic. The area is referred to as ‘the Bermuda Triangle of the buttock’ due to the fact that liposuction can severely damage the supportive gluteal ligaments. Damage to this area negatively affects sitting and moving.

Removing too much fat has adverse, dire consequences and possibly leads to diabetes: A study done on a transgenic (genetically modified) mouse in 1998 concluded: “The physiological consequences of having no white fat tissue are profound. The liver is engorged with lipid, and the internal organs are enlarged. The mice are diabetic, with reduced leptin (20-fold) and elevated serum glucose (3-fold), insulin (50- to 400-fold), free fatty acids (2-fold), and triglycerides (3- to 5-fold). The A-ZIP/F-1 phenotype suggests a mouse model for the human disease lipoatrophic diabetes (Seip-Berardinelli syndrome), indicating that the lack of fat can cause diabetes.” [112]

REGULATION ISSUES – 26

The medical industry cannot regulate itself. Surgeons often refuse to stand up against a fellow in their field, and they don’t wish to legally challenge the type of surgery they perform. The idea of expecting a doctor who makes his or her living from doing liposuction to testify against another in the same misguided field, is ineffective and allows all involved in the field (doctors, medical boards, the equipment manufacturers, and the FDA) to evade accountability. This sets the stage for continued harm.

Occasionally, there is a passing news story about a ‘non-board certified’ doctor or a spa performing harmful liposuction surgeries; [113] this erroneously puts the focus on these surgeons as ‘bad seeds’ instead of calling out the whole procedure as unsafe, which I believe I am showing that it is. True regulation doesn’t mean doing less of a harmful non-curative surgery; true regulation would mean completely doing away with the procedure.

The idea that liposuction is not well regulated is cited in multiple sources, including in Dr. Klein’s book, ‘Liposuction 101’ (Chapters 2, 3, and 5 are good sources). [114] [115] [116]

There are no clear industry standards — just fuzzy guidelines. Board certified or not, surgeons are just guessing about how much to resect, and they’re also guessing how invasive, unnatural removal of fat affects the health of their patients. Recall, “We’re just beginning to understand fat.” [117]  Recall, also, those ‘industry guidelines’ were created (according to the HTAC report) in an effort to ward off regulation. [118]

LEGAL CHALLENGES – LIPOSUCTION AND THE LAW – 27

In Florida, a state that has been touted as a national example for its regulations on plastic surgery, at least eight deaths were reported in less than two years. [119] Those statistics do not include disfiguration, chronic pain, or other complications of liposuction, nor do they explain that liposuction changes the fat distribution patterns of each individual, causes long-term fat mobilization, metabolic syndrome, and increase in insulin resistance.

Based on public outrage following these deaths, the Florida legislature set some parameters as to how much fat aspirate can be suctioned out of each individual at one time. Instead of the 5 liters of aspirate (fat tissue, blood, and serous fluid) that most other states allow, Florida reduced the amount: 5 liters is still okay in hospital or Ambulatory Centers; 4 liters in spas; 1 liter when liposuction is performed with another procedure. [120]

Liposuction in the US is recommended for fit, healthy people with ‘slight contour irregularities’. The legal amount in many states is 5 liters to remove ‘at-one-go’ – with or without unrelated surgeries (picture 5 liters of water as reference). But, how many fit people with slight contour irregularities have 5 liters of tissue ‘to spare’? Also, stating the number as a legal ‘one-size-fits-all- figure is not equitable; a petite, fit person has a very different body make-up than a large, tall and/or obese person.

In the UK, government regulations limit the amount of liposuction aspirate to be removed to three and ½ liters at a time. [121] Regulations that limit the amount of liters of fat can be removed in one session may lessen a few complications – such as intense fluid imbalance and so on, but the current regulations aren’t good enough; they still don’t protect people because ‘less of’ a harmful procedure is still a harmful procedure.

Even in situations when harm due to liposuction is recognized as being egregious, it’s difficult to get a malpractice lawyer: Lawyers say that juries are prejudiced against people who have cosmetic surgery and there is a “white coat of silence” (i.e. it’s hard to find surgeons willing to stand up against fellows — especially as outing the offending doctor may bring to light questions about the dubious nature of liposuction). Medical Injury Compensation laws exist in about 37 states. These laws limit financial settlements for victims of surgical harm making it challenging and unappealing for lawyers to take on cases that require costly (and unwilling) ‘surgical experts’. [122]

When doctors are not held legally accountable, unsound medical practices remain unchallenged. In America, it is possible to be the victim of surgical battery via liposuction but due to the legal roadblocks, the offending surgeon might get off without penalty – without even a trial – and remain free to maim the next unsuspecting patients.

Many state medical boards are not doing their jobs effectively enough; the laws don’t support the kind of strong patient protection that should be established. In May 2013, it was reported on a Los Angeles news segment (KCAL news) entitled, ‘Doctors from Hell’, that Attorney General Kamila Harris was thinking of taking over the job of repudiating unsavory doctors after dozens of liposuction victims stepped forward to complain about being disfigured. Also in May, 2013, My Fox LA, aired a news report entitled, ‘Bad Liposuction.’ How many more disturbing news reports do we need?

FINANCIAL CONFLICT OF INTEREST – 28

According to PubMed, the major stock indices are affected by liposuction consumption. [123] In other words: liposuction is very big business. Doctors (and others) are financially invested in covering up the harm caused by liposuction, which is a procedure that has proven to be unsafe, resulting in negative, long-term health consequences. Studies done by doctors who make a living by performing liposuction may be biased in comparison to studies done by scientists whose financial incentives aren’t tied to the results.

CONCLUSION – 29

Liposuction surgery is an invasive, non-curative, harmful surgery. The complications from this surgery are not accurately followed. Because the reporting of adverse affects is not mandatory, [124] and doctors may have a different criterion to classify a ‘bad outcome’ than patients, patient self-reporting can give a more accurate representation.

The HTAC issued this caution in 2002: “Death and disfigurement due to the cosmetic surgical procedure of liposuction should be a matter for serious public concern.” [125] Sadly, the liposuction politic has continued on since then, and patients are still being harmed on a widespread basis. Even patients who initially feel satisfied with a cosmetic outcome have had their bodies irreversibly changes in ways that will negatively affect their long-term physical and mental health, and their overall well-being.

No matter how often it is renamed, or how the medical community spins it, liposuction is unsound. Scientific studies remind us that, regardless of the surgeon, the problem of liposuction has to do with the biology of fat.

Since liposuction increases visceral fat, causes long-term fat mobilization, increases insulin resistance, and instigates metabolic syndrome – and all of these affects are so detrimental to one’s health – then isn’t representing liposuction surgery as being a valid medical procedure actually false advertising?

Is the role of our doctors to attain and maintain a high standard of medical and ethical conduct, or to remove healthy fat that is vital for metabolism and other bodily functions? Liposuction is responsible for a spectrum of harm including:

  • Permanent damage to muscles, nerves, underlying organs
  • Painful skin adherence which is disabling and limits sitting and mobility
  • Disturbing fat regrowth causing unnatural, disfigured appearance
  • Possible increased in visceral fat which is linked to slowed metabolism and disease conditions known to shorten life
  • Infertility and difficulties with lactation
  • Loose sacks of skin that require risky skin excision and fat grafting
  • Sunken pockets of divots
  • Lack of transparent, clearly-communicated consent
  • Problems of exceeded consent
  • Financial hardship and even ruin
  • Chronic pain, loss of quality of life
  • Lidocaine toxicity, third-space swelling, Death

 

With the many known problems attributed to liposuction, barring being outlawed, a National Liposuction Registry should be created that requires mandatory reporting of each procedure. The registry should require reports of mortality, and include a venue for patients to provide their own data at any time post-surgery, since the full aggregate of complications does not present immediately. Also, detailed scans should be required.

With regards to liposuction, a doctor may only consider such events as death or a lawsuit to be a ‘poor outcome’ but a patient may consider a ‘poor outcome’ to be chronic pain, lessened or ruined quality of life, the disfiguration of his or her body via fat distribution, and the unexpected shortening of his or her lifespan due to the disease processes.

Our bodies require healthy fat to function. Liposuction is marketed for ‘slight deposit contour’ issues on people at their best and stable weight.  The literature on liposuction states it is not intended to assist obese individuals as a form of weight loss, yet surgeons suction liters of tissue from healthy bodies. Instead of solving ‘slight contour’ issues, liposuction creates significant problems including pain and disfigurement for life.

Since the cosmetic issues to be ‘fixed’ are more benign than the resultant adverse long-term aesthetic and health complications of liposuction, there doesn’t seem to be a compelling reason to harm healthy individuals. Certainly some surgeons (board certified or not) are worse than others, but the procedure is dangerous and inherently flawed leaving many patients desperate, disfigured, or dead.

The question posed here is, ‘Why is a procedure that is so incredibly harmful to the patients health being performed at all?’ 

 

REFERENCES:

[1] Health Technical Advisory Committee Report, Minnesota, 2002 Executive Summary – Liposuction. http://www.health.state.mn.us/htac/lipo.htm

[2] Health Technical Advisory Committee Report

[3] Evidence-Based Patient Safety Advisory: Liposuction, Plastic Surgery Reconstructive Journal, 2009. http://www.researchgate.net/publication/46189910_Evidence-based_patient_safety_advisory_liposuction

 [4] LipoRepair. Approach to correction of fat tissue deformities, http://www.ncbi.nlm.nih.gov/pubmed/15184991

[5] Liposuction 101, Dr. Klein/ http://www.liposuction101.com/liposuction-textbook/chapter-5problems-in-reporting-liposuction-deaths/

[6] PR Web. Surgeon Warns Cosmetic Surgery Patients to Avoid Poor Outcomes http://www.prweb.com/releases/liposuction/warnings/prweb4275934.htm

[7] Juan Brou, Consumer warning

[8]  Fat Redistribution Following Suction Lipectomy: Defense of Body Fat and Patterns of Restoration http://www.nytimes.com/2010/08/31/health/31brod.html?_r=0

[9] Health Technical Advisory Committee Report

[10] Health Technical Advisory Committee Report

[11]  Health Technical Advisory Committee Report

[12] Dujarier’s case http://www.ncbi.nlm.nih.gov/pubmed/2473691

[13] Liposuction 101, Chapter 5, Dr. Klein

[14] WebMD feature article by Kathleen Doheny, reviewed by Louise Change, MD http://www.webmd.com/diet/features/the-truth-about-fat

[15] Fat Redistribution study article

[16]  Liposuction is a Big, Fat Lie http://www.naturalnews.com/032385_liposuction_body_fat.html#

[17]  Fat Redistribution study article

[18] Clinical Trials.gov. FLARE Study, UC Denver http://clinicaltrials.gov/ct2/show/NCT00995631?term=liposuction&rank=17

[19]  Daily Mail, Visceral Fat, by Jane Feinmann http://www.dailymail.co.uk/health/article-1258185/The-toxic-fat-strangle-organs-shed-it.html

[20]  Link between Liposuction and Skin Cancer in Mice http://www.mylooks.com/blog/study-liposuction-reduces-risk-of-skin-cancer-in-mice/

[21] Fat Redistribution study article

[22] Fat Redistribution study article

[23] Fat Redistribution study article

[24] Fat Redistribution study article

[25] Fat Redistribution study article

[26] Fat Redistribution study article

[27] Fat Redistribution study article

[28] Fat Redistribution study article

[29] Liposuction Techniques http://www.liposuction.com/liposuction-technique.html

[30]  The “Complications of Liposuction”

http://ebookbrowse.com/intech-complications-of-liposuction-pdf-d304681825

[31]  Cosmetic Surgery and Treatments: How Safe Are They? http://blog.womenshealth.northwestern.edu/2012/01/cosmetic-surgery-and-treatments-how-safe-are-they/

[32] Daily Mail, The Truth About Liposuction, by Rosemary Leonard GP, MB http://www.dailymail.co.uk/femail/article-4483/The-truth-liposuction.html

“The Complications of Liposuction”

[33] Dr. Klein, Liposuction 101

[34]  Dr. Klein, Liposuction 101

[35] Informed Consent, American Society of Plastic Surgeons 05/09/2009 http://www.advancedplasticsurgery.com/pdf/consents/body/Liposuction%20-%20Suction%20-%20UAL.pdf

[36] “The Complications of Liposuction”

[37]  Source, dermatologists fault PS

[38] Fat Redistribution study article

[39] Referred to as ‘the Gold Standard’ in board certification http://www.pmrsurgery.com/plasticsurgery/certification.html

[40] Abplsurg.org: ‘Is your surgeon certified?’ https://www.abplsurg.org/ModDefault.aspx?section=PubFind

[41]  Is your surgeon certified?

[42]  Tumescent Liposuction http://www.liposuction.com/tumescent-technique.html http://www.mysmartlipo.com/liposuction-tumescent.htm

[43]  Health Technical Advisory Committee Report

[44] Dr. Klein, Liposuction 101

[45]  “The Complications of Liposuction”, Health Technical Advisory Committee Report

[46] “The Complications of Liposuction”, Health Technical Advisory Committee Report

[47] Tom from Australia details how doctors suctioned out muscle instead of fat during liposuction. He includes MRI’s. http://liposuctionruinedmylife.com/

[48] Fat Redistribution study article

[49] Fat redistribution following suction lipectomy: defense of body fat and patterns of restoration http://www.ncbi.nlm.nih.gov/pubmed/21475140?dopt=Abstract

[50] Evaluation of the risk of systemic fat mobilization and fat embolus following liposuction with dry and tumescent technique: an experimental study on rats http://www.ncbi.nlm.nih.gov/pubmed/19690909

[51] Subcutaneous lipectomy causes a metabolic syndrome in hamsters, American Journal of Physiology, March 31, 2000 http://ajpregu.physiology.org/content/279/3/R936.full.pdf

[52] Insulin resistance shows significant increase in liposuction, and is correlated to the volume of aspirated fat. http://www.ncbi.nlm.nih.gov/pubmed/23538534

[53] The Truth About Liposuction, Rosemary Leonard, PG

[54] Fat Redistribution study article

[55] Parker/Waichman, a National Law Firm http://www.yourlawyer.com/topics/overview/liposuction_malpractice 

[56] Since fat isn’t vascularized, recovery rates can be lengthy for liposuction surgery http://www.realself.com/blog/your-surgeon-your-body-lift-surgery

[57] Figuring body composition is complex, but doctors pinch fat and skin between their fingers and ‘guess’. http://www.realself.com/question/body-fat-accurately-concretely-measured-before-suctioning-through-liposuction

[58]  Financial Cost http://www.yourplasticsurgeryguide.com/liposuction/cost.htm

[59]  Juan Brou, Consumer warning

[60]  Fat grafting shrouded in stigma of variable results http://www.ncbi.nlm.nih.gov/pubmed/16936550

[61] Rohrich, M.D, R., Smith, M.D., P., Marcantonio, M.D., D., & Kenkel, M.D., J. (n.d.). The zones of adherence: Role in minimizing and preventing contour deformities in liposuction. Plastic and Reconstructive Surgery129(5S), 86S-93S. Retrieved from http://journals.lww.com/plasreconsurg/Documents/Updates_in_Aesthetic_Surgery_0512_Article.14.pdf

[62]  Dr. Brou, Consumer warning

[63] Effects of major weight loss http://www.plasticsurgery.org/cosmetic-procedures/body-contouring-after-major-weight-loss.html

[64]  Some information on skin elasticity http://health.howstuffworks.com/skin-care/problems/treating/improve-skin-elasticity.htm

[65]  “Zones of Adherence”; Dr. Brou, Consumer warning

[66] A Toxic Fat Hides In Your Body Pumping Poison http://preventdisease.com/news/10/031910_toxic_fat_hides.shtml

[67] Dr. Rallie McAllister, on fat http://www.creators.com/health/rallie-mcallister-your-health/body-shape-fat-distribution-may-be-best-predictor-of-health-risks.html

[68]  WebMD, The Truth About Fat

[69]  Obesity Panacea, by Peter Janiszewski, Ph.D. http://blogs.plos.org/obesitypanacea/2011/04/26/liposuction-does-not-permanently-remove-fat/

[70]  Rallie McAllister, on fat

[71]  Fat Redistribution study article

[72] Clinical Trials.gov. FLARE Study, UC Denver

[73] Prevent Disease.com, Toxic fat Pumping Poison http://preventdisease.com/news/10/031910_toxic_fat_hides.shtml

[74]  Daily Mail, Visceral Fat article

[75]  Medscape, Hypovolemic Shock http://emedicine.medscape.com/article/760145-overview

[76]  Fat redistribution following suction lipectomy: defense of body fat and patterns of restoration http://www.ncbi.nlm.nih.gov/pubmed/21475140?dopt=Abstract

[77]  Fat embolism syndrome http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665122/

[78] Evaluation of the risk of systemic fat mobilization and fat embolus following liposuction with dry and tumescent technique: an experimental study on rats http://www.ncbi.nlm.nih.gov/pubmed/19690909

[79]  Insulin Resistance and Pre-diabetes http://diabetes.niddk.nih.gov/dm/pubs/insulinresistance/

[80]  Insulin resistance shows significant increase in liposuction, and is correlated to the volume of aspirated fat. http://www.ncbi.nlm.nih.gov/pubmed/23538534

[81] Metabolic Syndrome http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004546/

Metabolic syndrome is associated with increased risk of common cancers http://www.medscape.com/viewarticle/773939

[82]  Subcutaneous lipectomy causes a metabolic syndrome in hamsters, American Journal of Physiology, March 31, 2000 http://ajpregu.physiology.org/content/279/3/R936.full.pdf

[83] Estrogen Tells Brain Where Fat Goes http://www.webmd.com/menopause/news/20070820/estrogen-tells-brain-where-fat-goes

[84] Nutrition Wonderland, Understanding Our Bodies: Leptin http://nutritionwonderland.com/2009/06/understanding-our-bodies-leptin-the-fullness-hormone/

[85]  Adipose Tissue Regeneration Following Liposuction http://www.sciencemag.org/content/197/4301/391.short

[86]  Photoperiod-dependent fat pad mass and cellularity changes after partial lipectomy in Siberian hamsters http://ajpregu.physiology.org/content/270/2/R383

[87]  The regulation of total body fat: lessons learned from lipectomy studies http://www.sciencedirect.com/science/article/pii/S0149763400000476

[88]  RealSelf – 3.5 million monthly visitors http://www.realself.com/realself-top-100-doctors#.UppvSaVLzlI

[89] Real Self is an advertising MECCA for doctors http://www.realself.com/spotlight

[90] Slim woman being told to get liters of fat removed http://www.realself.com/question/good-candidate-for-u-l-abdominal-waist-and-flank-liposuction

[91] Meet RealSelf: the profitable under-the-radar plastic surgery site. http://pandodaily.com/2013/01/23/realself-makes-plastic-surgery-transparent/

[92] RealSelf made 2.4 million in 2011http://www.bizjournals.com/seattle/print-edition/2012/10/12/realselfcom-serves-potential-cosmetic.html

[93]  Pando Daily, RealSelf

[94]  RealSelf, About Us, http://www.realself.com/about

[95]   http://www.plasticsurgery.org/News-and-Resources/Press-Release-Archives/2012-Press-Release-Archives/Fat-Cells-Don’t-Return-to-Treated-or-Untreated-Areas-After-Liposuction-ASPS-Study-Finds.html

[96]  Challenges to study http://finance.yahoo.com/news/dr-elizabeth-fox-liposuction-study-172835795.html

[97]  Figuring body composition is complex. Exercise Physiology McArdle, Katch & Katch http://www.weber.edu/wsuimages/mollysmith/3510Presentations/Body%20Composition.ppt

[98]  Exercise Physiology, McArdle, Katch & Katch

[99]  http://en.wikipedia.org/wiki/Body_mass_index

[100] Discovery Channel, ”Cosmetic Surgery Gone Wrong.” Garden Film Entertainment 2001. VHS #763607. Kelleher, Susan.

[101] Brown adipose lipectomy leads to increased fat deposition http://www.deepdyve.com/lp/the-american-physiological-society/brown-adipose-tissue-lipectomy-leads-to-increased-fat-deposition-in-ldmySjL4Uf?articleList=%2Fsearch%3Fquery%3Dbrown%2Badipose%2Btissue%2Blipectomy%2Bleads%2Bto%2Bincreased%2Bfat%2Bdeposition%2Bin

[102] Lots of Small Cells Are Better Than One Big One http://liionbms.com/php/wp_lots_small_cells.php

[103]  Lipoplasty claims experience of U. S. insurance companies

http://www.ncbi.nlm.nih.gov/pubmed/11373574

[104]  “Zones of Adherence”

[105]  “Zones of Adherence”

[106]  Liposuction 101, Chapter 36, Dr. Klein http://www.liposuction101.com/liposuction-textbook/chapter-36-buttocks/

[107]  AMA, American Society of Plastic Surgeons, Code of Ethics http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/about-ethics-group/ethics-resource-center/educational-resources/federation-repository-ethics-documents-online/society-plastic-surgeons.page

[108]  Cosmetic Surgery and Treatments: How Safe Are They? http://blog.womenshealth.northwestern.edu/2012/01/cosmetic-surgery-and-treatments-how-safe-are-they/

[109]  What are 501 (k) Clearance and Pre-Market Approval? http://www.devicewatch.org/reg/reg.shtml

[110]  “Complications of Liposuction”

[111] Health Technology Advisory Committee report

[112]  Life without white fat: a transgenic mouse, Genes Dev, Oct 1998 http://www.ncbi.nlm.nih.gov/pubmed/9784492

[113]  Mother dies with 22 stab wounds from liposuction surgery http://abcnews.go.com/Health/liposuction-tragedy-mothers-death-highlights-dangers-plastic-surgery/story?id=13890319#.UbZifxyQm4Q

[114] Liposuction 101 Dr. Klein. Standards of Care for Liposuction CHAPTER 2 http://www.liposuction101.com/liposuction-textbook/chapter-2-two-standards-of-care-for-liposuction/

[115]  Liposuction 101 Dr. Klein. Ethical Considerations CHAPTER 3 http://www.liposuction101.com/liposuction-textbook/chapter-3-ethical-considerations/

[116] Liposuction 101 Dr. Klein. Problems in Reporting Liposuction Deaths CHAPTER 5 http://www.liposuction101.com/liposuction-textbook/chapter-5problems-in-reporting-liposuction-deaths/

[117]  The Truth About Fat, article

[118]  Health Technology Advisory Committee Report

[119]  Florida puts limits on office plastic surgery after 8 deaths http://www.amednews.com/article/20040301/profession/303019951/7/

[120]  Cosmetic Surgery Laws Often Aren’t Enough http://www.usatoday.com/story/money/2012/12/10/cosmetic-surgery-laws-effect-debated/1759839/

[121]  Daily Mail, The Truth About Liposuction, by Rosemary Leonard GP, MB

[122]  Consumer Attorneys of California discusses Medical Injury Compensation Act http://www.caoc.org/index.cfm?pg=issmicra

[123]  Cosmetic surgery volume and correlation with major US stock market indices http://www.ncbi.nlm.nih.gov/pubmed/20601580

[124]  Health Technology Advisory Committee Report

[125]  Health Technology Advisory Committee Report

THIS PAPER IS STILL A WORK IN PROGRESS ~ Add these endnotes –

 

As Liposuction Deaths Mount, Study Exposes Cracks in Safety

by Michael Vlessides, Oct. 4, 2012 (Cut and paste this title info and that will take you to think link – they made it difficult to access this link.)

http://www.anesthesiologynews.com/Clinical-Anesthesiology/Article/10-12/As-Liposuction-Deaths-Mount-Study-Exposes-Cracks-in-Safety/21743/ses=ogst

 

Short and Long-Term Impact of Lipectomy on Expression Profile of Hepatic Anabolic Genes in Rats: A High Fat and High Cholesterol Diet-Induced Obese Model, Published: September 29, 2014

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0108717

 

The Secret Life of Fat, Sylvia Tara, PhD, Published December 27, 2016

https://www.amazon.com/Secret-Life-Fat-Science-Understood/dp/0393244830

 

Liposuction Doesn’t Offer Health Benefit, Study Find, June 25, 2004 http://www.nytimes.com/2004/06/17/us/liposuction-doesn-t-offer-health-benefit-study-finds.html?_r=0

 

REAL SELF: a doctor-led traffic network that exploits the maimed & swipes user-generated content

http://www.ripoffreport.com/r/realselfcom/internet/realselfcom-realself-real-self-ask-a-doctor-Beware-Phony-review-site-Realselfcom-Int-1175963#comment_1

 

Flip Out Mama, Story about how the information about Krista Stryland’s death were taken off rip off report – this is the cover up that is commonly happening online http://www.flipoutmama.com/2012/02/today-i-am-going-to-share-story-that.html?spref=tw

 

Sitejabber – Reivews of RealSelf.com

http://www.sitejabber.com/reviews/www.realself.com

http://www.sitejabber.com/reviews/www.realself.com#24

 

 

 

MEDICAL DISCLAIMER: The information presented in this paper is offered for educational and informational purposes only, and should not be construed as personal medical advice or instruction. The information provided here is believed to be accurate based on the best judgment of the author, but the reader is responsible for his or her own health. In addition, medical information changes rapidly. Therefore, some information referred to here may be out of date or even possibly inaccurate and erroneous. The author/s do not assume any liability for the information contained herein, be it direct, indirect, consequential, special, exemplary, or other damages. The text is written to cover a wide basis of complaints.

 

 




Guest Post: Fitness Challenges of Older People and How to Overcome Them

By Gary Baker

Being an older fellow and trying to be physically fit can be a daunting combination. However, speaking as someone that started his journey at the age of 47, I feel I have some important experiences to share about the fitness challenges of older people and how to overcome them. It definitely was a struggle going from an average “dad” body with a beer belly to having the energy to exercise every single day for the past few years. Despite this immense battle to get in shape, I can say it was worth it not only for my physical well-being, but for the new joys I found in doing so as well as the relationships I strengthened through fitness.

Today, I am excited to share some of the challenges I faced in my personal journey. It is important to note, though, that my end goal for myself was not to be able to lift a specific weight or become absolutely shredded. I merely wanted to live a more active lifestyle and do the things I already enjoy such as hiking, swimming, or sports with the kids, without the trouble that typically comes with age.

Transitioning 

I will be the first to admit that the transition from my previous lifestyle, one with hardly any exercise, to my new one was not pretty. Remember, I only started at 47 years of age, meaning I had decades of conditioning my body to be “average”. As an adult, I never seriously visited the gym to get stronger or burn calories. To be quite frank, for as long as I was alive at that point, I simply… existed. I ate what I want and exercised only if I wanted to, never really pushing myself toward any particular goals. Thankfully, living like that did not result in me becoming obese, which would have made the journey even more vigorous.

Even so, I remember wanting to give up within a week of trying out my new habits. One of the goals I set for myself was to cut the coffee and instead go for a morning jog to activate my body. Now, these jogs, at least at the start, were not supposed to be difficult at all. They were only supposed to span a few minutes so I can take in the environment while my system prepared for the rest of the day. Yet, only a few days in, I no longer felt the desire to step outside and put in that little effort.

 

Eventually, I was able to put it together. I considered the long journey to physical health, and my motivation came back. That motivation turned into discipline a few weeks in, and before I knew it, morning jogs were part of my daily routine. It felt different not to do a morning jog. The lesson here is to always go back to why you started doing it in the first place, and then understand that it is going to take more than a few days to get to where you want.

Time 

This challenge applies to virtually everyone wanting to get more fit, though it is more apparent in older adults, as jobs, families, and friends can all get in the way. Especially after years of having the same lifestyle and doing the same type of things everyday, I found it particularly hard to make time for fitness.

The way I overcame it was with some mental management. I made a conscious effort to look at my goals with a different perspective. Rather than considering only the end game, I really tried to look at the entire journey as part of my new life. Instead of thinking of my jogs and diets as chores I had to maintain, I tried to think of them as part of my life. Once you get into the habit of acknowledging these new activities as “normal” and just normal things you do, it becomes that much easier to make time for them.

Pain of being old

 Now, this obstacle is one that I feel is specific to older people and one that was one of my biggest concerns going in. Just being an older guy was a challenge in itself. Like I mentioned earlier, being old and working out is very hard. We get shortness of breath faster, our muscles are typically weaker, and bones and joints start to deteriorate.

I remember my first time hiking. The hike only lasted around an hour and a half, but the day after I was awfully sore. My knees and back were stiff, and both my upper and lower leg muscles felt weaker than the day prior.

Still, I did not give up. I did some research on how to get through the specific hurdles I faced and tried to keep going. I took joint pain relievers, started taking more vitamins, and tuned my diet to allow for more useful energy.

Being old definitely is a hardship if you are on your way to living more actively. However, it should not be an excuse not to start. I always try to encourage people similar to myself to get going, because like them, I nearly gave up from being so used to living how I did. It all didn’t seem worth the effort. But I overcame those thoughts and now live happily. I spend a lot of time with family doing things they, in their physical primes, like to do. Before, I used to not even challenge myself to do fun things like that, but now I am not only up to the task, but I feel this enhanced bond with the people I love.

Author bio: Gary is a retiree and now blog manager of the active living and fitness site ActiveAuthorities.com. On the site, he encourages people to form new habits, as it is never too late to begin. He also writes product analyses for hobbies he has, such as his Callaway Supersoft golf ball review.

PS: To get in the best shape of your life whether you’re young or old, skip the Starbucks today and invest the savings in my book, Muscle Up.

PPS: Check out my Supplements Buying Guide for Men.




CHEKD + Rogue Health and Fitness Optimized Health

I’ve teamed up with Aaron Grossman, M.D. of CHEKD to offer comprehensive lab testing and medical exams.

Dr. Grossman founded CHEKD to provide a network of physicians who are able and willing to test patients for testosterone and to treat with testosterone replacement therapy if warranted; and to test for iron and treat with therapeutic phlebotomy if warranted.

 

 

Health Optimization

CHEKD + Rogue Health and Fitness offers health optimization for those, men and women, who want to take their health to the next level.

  •  Expert Consult: Discuss your results with an actual Health Professional who understands what Real Optimization means. Yes, an actual conversation.
  • Personalized: Protocols and plans tailored to your actual numbers and personal goals. Only what you need, nothing more.
  •  #1 Across the Board: We only provide the best Practitioners, Pharmacies and CLIA Certified Laboratories. American Made.

CHEKD + Rogue Health and Fitness offers four levels of testing and examination, three of which come with a complete physical exam by a qualified physician.

Testosterone Replacement Therapy

Given the epidemic of low testosterone, many men are interested in testing and treatment, but finding the right doctor can be difficult. Many, probably most, doctors won’t treat with TRT (testosterone replacement therapy). Even if you can find a doctor, he may not be in your area.

CHEKD offers a network of physicians who are willing to test for low testosterone, and treat it if necessary, and within this network you can find a doctor near you.

Therapeutic Phlebotomy

If you have excess ferritin (iron), blood donation is the quickest and most sure way of dealing with it. But some people are ineligible to donate blood. Plus it can be a hassle.

Therapeutic phlebotomy works just like a blood donation, but the blood is discarded instead of transfused into another person. In addition, blood donors must wait 8 weeks between donations, while therapeutic phlebotomies can typically be scheduled more often, and when you want.

However, just as with TRT, few doctors even recognize a problem with excess iron unless it’s very high, and most are also unwilling to order a therapeutic phlebotomy unless the same conditions are met, that is, very high iron.

If you want to take your health to the next level, take a look at CHEKD.

Read testimonials here.




From My Forthcoming Book: Can You Get Too Many Plant Polyphenols?

In my forthcoming book on supplements, Best Supplements for Men, I give some consideration to the dosage of polyphenols, the beneficial plant chemicals that are associated with much lower death rates. Can you get too many plant polyphenols? Are all plant polyphenols created equal? Read on for my thoughts on that topic. The book is in progress.

Polyphenols: The Right Dose

Several of the supplements in this section [of the book], including resveratrol, green tea, curcumin, quercetin, and berberine, are polyphenols, a class of chemicals found in plants. In addition, coffee, black tea, chocolate, and red wine contain relatively large amounts of these phytochemicals. If you consume these foods/beverages and also supplement, is it possible to get too many polyphenols?

Consumption of polyphenols is robustly associated with better health and 37% lower death rates,  as well as a 46% reduction in cardiovascular disease risk. However, these studies were based on the polyphenol content of foods, such as coffee, fruits and vegetables, etc., as well as a spot urine test for polyphenols, not supplement use. The highest intakes of polyphenols, that is, those associated with the lowest death rates, averaged about 1235 mg a day.

Polyphenols in food

To get a handle on this, it helps to know the polyphenol content of some common food items, notably those high in them as we’ve discussed. I’ve listed the total polyphenol content, by serving, in the following, calculated from the amount in 100 grams or in 100 ml from “Identification of the 100 richest dietary sources of polyphenols: an application of the Phenol-Explorer database”.

  • Dark chocolate: ~500 mg
  • Coffee: ~300 mg
  • Black tea: ~150 mg
  • Green tea: ~120 mg
  • Red wine: ~150 mg

 

Someone who drinks two regular-size (6-ounce) cups of coffee daily, eats a serving of dark chocolate, and drinks two glasses of red wine (for example), will have a polyphenol intake of around 1400 mg. (Rough calculation.) That’s about the level seen in the highest category of polyphenol consumption and the category with the lowest death rates. Using some different assumptions, it would appear to be relatively easy to get total daily polyphenol uptake into the several-thousand-milligram daily range. In fact, a 20-ounce coffee of the kind sold in chain coffee shops may alone have 1200 mg of polyphenols.

For comparison, some of the doses of supplements we’ve discussed, such as berberine and curcumin, are 500 mg. Resveratrol suggested doses are lower, at 100 mg or less.

Could you get too many plant polyphenols? Or is there even such a thing as too many?

Hormesis and polyphenols

Unfortunately, the answer is not known. It may or may not follow that, because those who consumed 1250 mg of polyphenols a day had the lowest death rates, those who consumed 2500 mg a day have even lower death rates. Maybe they do, maybe they don’t.

A point of diminishing returns likely exists somewhere. Furthermore, not all polyphenols are the same and some have greater effects than others and/or use different mechanisms of action, so adding them into all one basket for purposes of calculating total intake may be of limited value.

Stilbenes and lignans

The study that found 37% lower death rates also reported, “Among the polyphenol subclasses, stilbenes and lignans were significantly associated with reduced all-cause mortality [HR 0.48 and 0.60, respectively], with no significant associations apparent in the rest (flavonoids or phenolic acids).”

If polyphenols cause lower death rates (not mere association), then only certain classes of them count for much.

The two classes of polyphenols that mattered were stilbenes, which include resveratrol, pterostilbene, and other compounds in grapes, wine, and cocoa; and lignans, the richest source of which is flaxseed.

Since polyphenols most likely work through hormesis, the process by which low doses of toxins or stressors produce beneficial health effects, it follows that at some dosage, polyphenols may become overtly toxic, and damage health.

The point I wish to make is to be aware of what you’re taking and not to overdo it. Don’t indiscriminately take large amounts of different polyphenol supplements in the quest for ever better health, especially if you already drink coffee, tea, and wine, and eat chocolate. Not to mention berries (another source of large amounts of polyphenols) or if you cover your food with cloves (just kidding, but that’s the number one food for polyphenols).

Although we don’t know at what, if any, level that polyphenols become a problem, and overt toxicity in animals seems to occur only at very high doses, if you tally up your polyphenol intake and find it at, say, over a couple thousand milligrams daily, you might consider cutting back. These considerations may not apply to those with special health needs, such as someone taking berberine several times a day for blood sugar control, but such people should have cleared their use of supplements with their doctor first.

PS: Check out my Supplements Buying Guide for Men.

Notes

Tresserra-Rimbau, Anna, et al. “Polyphenol intake and mortality risk: a re-analysis of the PREDIMED trial.” BMC medicine 12.1 (2014): 77.

Tresserra-Rimbau, Anna, et al. “Inverse association between habitual polyphenol intake and incidence of cardiovascular events in the PREDIMED study.” Nutrition, Metabolism and Cardiovascular Diseases 24.6 (2014): 639-647.

Pérez-Jiménez, J., et al. “Identification of the 100 richest dietary sources of polyphenols: an application of the Phenol-Explorer database.” European journal of clinical nutrition 64 (2010): S112-S120.




Aspirin, Salicylate, and Cancer

Following are some thoughts on aspirin, salicylate, and cancer.

Executive Summary:

  • Aspirin prevents cancer
  • Aspirin has two modes of action, due to acetylation and salicylate
  • Salicylate prevents cancer through iron chelation and AMPK activation
  • Willow bark contains a high amount of salicylate
  • Polyphenols in willow might be important
  • Salicylate may prevent cancer without the side effect of bleeding

Aspirin prevents cancer

Aspirin is well known to prevent cancer. A number of epidemiological studies, as well as randomized controlled trials have found that people who take aspirin, and especially those who’ve taken it longer than 5 years, have much lower cancer rates.

How much lower?

In randomized controlled trials, the biggest decrease was in cancers of the gastrointestinal tract, which were 54% lower after 5 years of aspirin use; with 7.5 years of use, 20-year gastrointestinal cancer rate was 59% lower. (Note: this is a bit confusing; what it means is that someone who used aspirin for 7.5 years benefited over 20 years, even though they didn’t necessarily take aspirin the entire time, i.e. aspirin decreases cancer even after you stop taking it.)

For all cancers, the decrease in risk was 34% with 5 years of aspirin use.

Why does aspirin decrease cancer? Lots of ideas have been floated, perhaps the most popular being that aspirin inhibits the enzymes COX-1 and COX-2 (cyclooxygenase 1 and 2), which is involved in inflammation and pain. Another possible mechanism is that aspirin lowers levels of iron, such that people who take it for years have substantially lower body iron stores.

To understand how aspirin might protect against cancer, we need to know something about its pharmacology.

Pharmacology of aspirin

Chemically, aspirin is acetylsalicylic acid, hence it’s often referred to as ASA. When aspirin is ingested, enzymes rapidly remove the acetyl group, leaving salicylate and acetate.

 

Image result for aspirin metabolism

 

The acetyl group then attaches to COX-1, the dominant COX enzyme in blood platelets, disabling them. Platelets are responsible for forming clots after a bleeding episode.

One low-dose aspirin tablet irreversibly disables platelets, because the platelets are unable to synthesize new enzymes. The inhibition of platelet function is antagonized by newly formed platelets, which enter the circulation at the rate of 10 to 15% daily. (Hence platelets turn over every 7 to 10 days.) A loading dose of one regular dose (325 mg) aspirin disables platelets faster, which is why a regular size aspirin is used when a patient is having a heart attack. The arrival of new platelets daily means that, in order to maintain an optimal anticlotting effect, aspirin must be taken daily.

So, after the acetyl group is jettisoned, salicylate remains, and this molecule is also active. The active ingredient of willow bark, from which aspirin was originally derived, is salicin, and when ingested, salicin becomes salicylate, the active drug. Taking salicin or salicylate does not cause an anti-clotting effect; salicylate is responsible for the effect of diminishing pain and inflammation.

Back to cancer. It turns out that salicylate activates AMPK, the master metabolic switch that increases mitochondrial biogenesis and fat-burning. This makes salicylate similar to exercise and calorie restriction as well as resveratrol and berberine. Both cancer and atherosclerosis may be inhibited by activating AMPK. Oddly, the protective effect of aspirin against coronary artery disease may be due partly to this mechanism of salicylate, and not entirely because of the anticlotting effect of the acetylation of COX-1 in platelets.

Both aspirin and salicylate inhibit colon cancer cells in vitro. Salicylate also inhibits pancreatic cancer cells and breast cancer cells.

Both aspirin and salicylate inhibit UV-B radiation-induced skin cancer in mice.

While the acetyl group of aspirin isn’t necessary to provoke cell cycle arrest and apoptosis (cell suicide) of cancer cells, platelets themselves may have a great deal to do with the progression of cancer. That means that aspirin could have two separate ways of preventing cancer, through the action of salicylates and by inhibiting platelet aggregation.

Salicylates activate AMPK only at relatively high doses, higher than could be expected through a daily low-dose (81 mg) aspirin.

Salicylate chelates iron

Interactions with iron may explain much of the anti-cancer effect of both aspirin and salicylate. Aspirin can result in lower iron levels either through direct iron chelation or the promotion of largely invisible intestinal microbleeding. Aspirin users typically lose small amounts of blood, perhaps on the order of 1 ml, daily, and that adds up over time and depletes iron stores.

Aspirin’s iron-chelating action stems from the salicylate moiety. Salicylate is such a powerful iron chelator – it binds and removes iron – that several species of bacteria make salicylate to use as a siderophore, a molecule that complexes with iron in the host or elsewhere in the environment and makes it available for bacterial growth. Iron is the limiting element for most pathogenic bacteria, and bacteria and their hosts battled each other in an evolutionary arms race for iron.

Willow bark, which is rich in salicylate (salicin), has anti-cancer properties; it suppresses growth and induces apoptosis in human lung and colon cancer cells. Willow bark is also rich in polyphenols and these appear to contribute to its painkilling and anti-inflammatory effects. Aspirin, at physiologically relevant doses, kills cancer cells by causing pro-oxidation reactions in mitochondria, and this does not affect normal cells with normal mitochondria. Aspirin and/or salicylate possibly could, from this viewpoint, be used in the metabolic therapy of cancer.

Willow bark has been known and used as a drug for thousands of years. Hippocrates himself recommended it.

An extract of willow bark was recently found to be the most potent plant extract in the extension of lifespan in yeast. While yeast may not be the most relevant model of lifespan extension, they’re commonly used in aging research and many substances and interventions that prolong their lives also prolong the lives of mammals.

Whether the polyphenols or the salicylate in willow bark are responsible for the lifespan effect in yeast is not known, but I suspect that both are involved. Aspirin extends lifespan in a number of models, including mice, but the results are not so spectacular that they make aspirin the most potent life-extension molecule. Salicylate, on the other hand, perhaps along with the phytochemicals in willow bark, just might be among the most powerful.

Salicylate appears to offer many of the anti-cancer and anti-aging properties of aspirin without as many side effects, mainly the tendency to bleed when that’s not wanted. However, at least some of the protective effect of aspirin against heart disease is necessarily entwined with the bleeding tendency, since inhibition platelet function both increases the risk of bleeding and prevents clots from forming in arteries. Aspirin has another mode of protection against atherosclerosis though, and that’s the ability of salicylate to chelate iron and lower body iron stores. The first, anti-platelet, mode works quickly, which is why aspirin taken by people having a heart attack; the second, iron-chelation mode is longer term, over a period of months to years if low-dose aspirin is used.

Just to be clear, I’m not recommending anything, whether aspirin, salicylate, or willow bark. Apparently some people (especially over on Twitter) think you’re not supposed to talk about this stuff, or if you do, you’re making some kind of recommendation. I’m just spreading the knowledge, my friends.

PS: To learn how you can live longer, you might want to invest a couple (OK, more than a couple) bucks in my book, Stop the Clock: The Optimal Anti-Aging Strategy.

PPS: Check out my Supplements Buying Guide for Men.




How to Make Lifting Weights a Maximum Anti-Aging Workout

A recent study found that high-intensity interval training (HIIT) robustly increased both aerobic capacity and mitochondrial function in both old and young people. The older people saw a greater increase in mitochondrial function, because they had a lower baseline function. This study has been making the rounds, calling HIIT “the best anti-aging exercise”. Here we’ll see how to turn lifting weights into a maximum anti-aging workout.

Decline in mitochondrial function is strongly linked to age and aging. In young people (and other young organisms), mitochondria, the powerhouses of the cell, function perfectly and with high efficiency, but with aging comes a falling off of that function. As mitochondria generate power, the decline literally means a decline in overall energy, the energy you feel. It probably explains a lot about why children have seemingly limitless energy, and why exercise improves the amount of energy you actually feel in everyday life.

Increasing mitochondrial function in older people improves their physiology and makes them much more like a young person.

HIIT vs resistance training

One little hitch for us weightlifters:

Here we report that 12 weeks of high-intensity aerobic interval (HIIT), resistance (RT), and combined exercise training enhanced insulin sensitivity and lean mass, but only HIIT and combined training improved aerobic capacity and skeletal muscle mitochondrial respiration.

The researchers reported no effect of resistance training (weightlifting) on better aerobic capacity and mitochondrial function.

Similarly, HIIT, but not continuous aerobic training, led to increases in PGC-1α, the molecule that upregulates mitochondrial biogenesis, i.e. signals cells to make more mitochondria to enhance energy generation.

Does all this mean that strength training does not improve health, or that we must perform HIIT to improve mitochondrial function and reverse aging?

Not at all.

We know that strength training increases VO2max, the measure of aerobic capacity. While VO2max is a general measure of function, including heart rate, circulation, hemoglobin, and lung function, it also includes mitochondrial function, the ability of the cells to use oxygen to make energy. For a good review, see Resistance Training to Momentary Muscular Failure Improves Cardiovascular Fitness in Humans: A Review of Acute Physiological Responses and Chronic Physiological Adaptations.

So, why didn’t the people who did resistance training in the new study see any improvement in mitochondrial function and aerobic capacity?

Most likely because of the way they trained.

I can speak from experience that most people who train with weights are hardly even trying. How so? They

  • do the traditional 3 sets of 10 reps, and rest between each set
  • they don’t lift until failure, but stop at a given number of reps
  • their between-set breaks are far too long
  • they spend a good deal of their gym time socializing or looking at their phones
  • they do isolation, not compound, exercises

This isn’t meant to be boasting on my part, just simple observation; in contrast, I

  • perform one set of each exercise to failure
  • move quickly to the next set
  • do compound lifts
  • rarely socialize and don’t even own a phone, much less take it to the gym

I frequently have to stop after a set to catch my breath, and this is especially obvious when I do big compound exercises, such as squats, deadlifts, T-bar rows, weighted dips, and the like. But I can’t even say when I’ve ever seen another weightlifter in my gym stop to catch his breath. I don’t know, maybe I’m not looking hard enough, but it’s striking.

When the new study put their trainees in resistance training, it’s highly unlikely that they did a high-intensity routine. They most likely did a standard 3 set per exercise protocol, with plenty of rest between sets, 3 days a week, etc.

Most people aren’t psychologically cut out to do high-intensity weightlifting. It’s too demanding. Which explains the general lack of progress seen in most gym-goers.

If your heart and lungs are not working intensely, at least some of the anti-aging benefits of strength training are lost to you.

How to increase mitochondrial function and VO2max with weightlifting

1. Here’s a good example of high-intensity strength training: Shawn Baker, M.D., deadlifting 405 pounds for 20 reps. Note that toward the end he pauses, and it looks to me like he does this not so much for his muscles, but to catch his breath.

Dr. Baker is 50-years-old, eats zero carb, and is a world-record holder in his age group for 1000 meter rowing.

Compound exercises, like deadlifts, squats, dips, bench, overhead, maximize the use of heart, lungs, and circulation, and will robustly increase mitochondrial function. Isolation exercises like biceps curls and triceps pulldowns are much less effective for this.

Note, this is not Crossfit, which carries a high risk of injury. All exercises must be done with good form and attention to safety.

2. Move quickly to the next set. “Quickly” is subjective of course, but don’t wait minutes or until you feel all rested and ready. Attack your workout.

3. Do an adequate number of repetitions. Lifting at your max weight for low reps (1RM) does little to improve cardiovascular conditioning.

4. Finally, you can always add a set or two of actual HIIT at the end of your strength training. For example, a 20-second all-out bout on the stationary cycle at the end of my workout leaves me gasping for breath. Sometimes I do a set or two of jump rope.

Conclusion

Weightlifting robustly increases VO2max and mitochondrial function, but it must be done right. Since the extent to which strength training improves VO2max depends on initial state of conditioning, someone who is already highly trained but wants to improve VO2max even more should add some HIIT to his strength training.

PS: For more on why strength training is the best anti-aging exercise, you know you want my book, Muscle Up.

PPS: Check out my Supplements Buying Guide for Men.




Possible Toxicity of Green Tea Extract

There are reports of possible liver toxicity with high doses of green tea extract (GTE), and since I’ve discussed GTE on this site, I felt I should address the issue here also.

The report mentions “dozens of cases” since 1999, and also that they’re caused by “high doses”, so given the huge number of people who have taken it for the past 18 years, the potential for toxicity is probably low. However, we can’t be sure.

The National Library of Medicine states:

Drinking green tea has not been associated with liver injury or serum aminotransferase elevations; indeed, cross sectional studies suggest that heavy use of green tea is associated with lower serum ALT and AST values.  Nevertheless, case series and a systematic review by the United States Pharmacopeia illustrate evidence for the potential for green tea extract to cause hepatotoxicity.  The prevalence of green tea extract induced liver injury is not known, but is probably low in comparison to the wide scale use of these products.  Liver injury typically arises within 3 months, with latency to onset of symptoms ranging from 10 days to 7 months.  The majority of cases present with an acute hepatitis-like syndrome and a markedly hepatocellular pattern of serum enzyme elevations.  Most patients recover rapidly upon stopping the extract or HDS, although fatal instances of acute liver failure have been described.  Biopsy findings show necrosis, inflammation, and eosinophils in a pattern resembling acute hepatitis.  Immunoallergic and autoimmune features are usually absent.  A small number of similar cases have also been described after drinking green tea “infusions” rather than taking oral preparations of extracts of green tea. 

The most prominent regulatory action against green tea containing products concerned Exolise, a weight loss product which was withdrawn from Spain and France in 2003.  Also, green tea is an ingredient in other supplements including most over-the-counter weight loss agents, some of which have been implicated in causing rare instances of clinically apparent acute liver injury.

While instances of liver injury appear to be rare, given the severity of liver injury, it may not be a good idea to take green tea extract.

I’ve taken green tea extract myself, but will now be stopping.




Is Viagra the Most Potent Heart Disease Drug?

Erectile dysfunction (ED) is associated with heart disease, which is logical, since erections depend on the circulation of blood, and arteries must be in a healthy state for both erectile function and heart health. The relation between the two conditions allows us to ask, is Viagra the most potent heart disease drug?

Viagra and similar drugs are associated with vastly fewer heart disease deaths

A just-published study took a look at a large number of Swedish men, 43,145 to be exact,  7.1% of whom got treatment for ED. Then the researchers looked at who died, had a heart attack, or who had heart failure. “Association between treatment for erectile dysfunction and death or cardiovascular outcomes after myocardial infarction.”

Men who got treatment for ED with Viagra had a large reduction in both deaths and hospitalization for heart failure. Reduction in deaths was 33% overall, 40% for heart failure.

Importantly, reduction in death rates appears to be dose dependent.

Men who got 1 prescription for Viagra had 34% fewer deaths.
Men who got 2 to 5 prescriptions had 53% fewer deaths.
Men who got greater than 5 prescriptions had 81% fewer deaths.

Only men who got Viagra for ED had lower death rates. There was no association with death rates for those who got another form of treatment for ED, alprostadil.

What in the world is going on here? The answer can lead us to the true cause of heart disease.

Nitric oxide

Viagra (sildenafil), and the other drugs in this class, such as Cialis and Levitra, are inhibitors of an enzyme abbreviated PDE5, hence they’re called PDE5 inhibitors. They result in an increase in nitric oxide in endothelial cells, which form the lining of blood vessels. In turn, nitric oxide (NO) dilates blood vessels and is critically important in maintaining vascular health.

NO has been implicated in a number of cardiovascular diseases and virtually every risk factor for these appears to be associated with a reduction in endothelial generation of NO. Reduced basal NO synthesis or action leads to vasoconstriction, elevated blood pressure and thrombus formation… Appropriate pharmacological or molecular biological manipulation of the generation of NO will doubtless prove beneficial in such conditions.

The study on Viagra and heart disease deaths only shows association, not causation, and the researchers caution that men who took Viagra may have been in better health to begin with, although none of the men in the study had had a heart attack at the start of the study.

But we can see a mechanistic link between Viagra, which dilates blood vessels that allow erections, and less heart disease, due to better blood vessel function, lower blood pressure, and lower tendency to form blood clots.

Viagra blows statins out of the water

Statin drugs are used to lower cholesterol and allegedly prevent coronary artery disease.

In high-risk populations, that is, in people with existing coronary artery disease, a meta-analysis showed that statins had no statistically significant effect in decreasing death rates.

Earlier studies found a benefit to statins, but we need to keep in mind the biases in studies funded by pharmaceutical companies. After 2004, when full disclosure regulations came into effect, statins appear to have stopped working. That is, studies done before full disclosure found lost of benefit, afterwards they found little to no benefit.

Either way, Viagra showed a huge reduction in deaths, much greater than statins.

Nitric oxide and heart health

The working of the lining of blood vessels, or endothelial function, is critical for arterial health, and endothelial dysfunction is a marker of atherosclerotic disease.

Endothelial dysfunction is a systemic disorder and a key variable in the pathogenesis of atherosclerosis and its complications. Current evidence suggests that endothelial status is not determined solely by the individual risk factor burden but rather, may be regarded as an integrated index of all atherogenic and atheroprotective factors present in an individual, including known as well as yet-unknown variables and genetic predisposition. Endothelial dysfunction reflects a vascular phenotype prone to atherogenesis and may therefore serve as a marker of the inherent atherosclerotic risk in an individual.

Nitric oxide, as we saw above, is a crucial mediator of endothelial function.

Insulin resistance is strongly associated with heart disease. And insulin resistance causes endothelial dysfunction.

Given the huge reduction in death rates with Viagra as compared to statins, and assuming a mechanistic link between Viagra and the reduction, it sure looks like endothelial function, as mediated by nitric oxide, is far more important to heart disease than cholesterol.

How to increase nitric oxide and endothelial function

Besides Viagra, what else improves endothelial function through increases of nitric oxide.

Citrulline, a supplemental amino acid, treats erectile dysfunction and improves exercise performance. It does this through increasing nitric oxide signaling.

Vitamin D increases endothelial function.

Exercise increases flow-mediated dilation, the measure of endothelial function. “This may contribute to the benefit of regular exercise in preventing cardiovascular disease.” – Understatement of the year.

Iron massively decreases nitric oxide synthase activity, and iron chelators increase it.

For more on how to increase your health and lifespan, try a copy of Dumping Iron,  acclaimed by the world’s leading authority on iron and health, Leo Zacharski, M.D.

PS: Check out my Supplements Buying Guide for Men.




Control Your Mitochondria or They Will Control You

Mitochondria are small organelles within cells, popularly known as the powerhouses of the cell, since their main function is to burn energy. With a few exceptions, such as red blood cells, every cell in the body contains hundreds or thousands of mitochondria, and they are crucially important in aging. That’s why you must control your mitochondria or they will control you.

Aging mitochondria

Mitochondria are so important to aging that there’s an entire theory called the mitochondrial theory of aging.

As cells age, so do mitochondria, and they decline in capacity to make energy, generating reactive oxygen species (ROS, or free radicals), which cause self-damage as well as damage to the cells within which they reside.

Mitochondrial quality control is crucial to fighting aging.

Mitochondrial quality control

Perhaps the most crucial mitochondrial quality control process is autophagy, the cellular self-cleansing process that rids cells of junk. When mitochondria are subject to this process, it’s known as mitophagy. Mitochondria that are past their expiration date, that are inefficient and generating large amounts of free radicals, are sent through the meat grinder of autophagy, their constituents broken down and sent for recycling, and new mitochondria are built to replace them.

The decline in autophagy is one of the hallmarks of aging. An aging organism can no longer increase autophagy to the extent that it could when young. Autophagy is necessary because of the importance of maintaining clean cells. With aging, cells become cluttered and inefficient, and this is one of the crucial differences between young and old cells. Aging takes place most of all at the cellular level; aging cells mean an aging body. Maintenance of highly functional mitochondria is a characteristic of youth.

Insulin resistance is a characteristic of aging, and people with it have poorly functioning mitochondria.

Older people have lower exercise capacity and in general a lot less energy than young people. This is due in large part to declining mitochondrial function.

How to increase mitochondrial function

As you get older, and if you do nothing to intervene in the aging process, mitochondria decline in function and cause aging. In essence, if you don’t control your mitochondria, they will control you. Fortunately, there are a number of things you can do about this; most of them require some discipline.

Exercise

Exercise robustly increases mitochondrial function. A new study found that high-intensity interval training robustly increased the ability of mitochondria to generate energy, 69% greater in older people, and 49% in younger. The older people had a greater deficit in function, hence they had a greater improvement.

Intensity is a crucial component of exercise in every way, but especially so regarding improvement in mitochondria.

The study found that resistance training did not improve mitochondrial function (though it did improve insulin sensitivity), but this is likely because of training that wasn’t intense enough. Other studies have found increases in mitochondrial proteins involved in energy production in resistance training. That’s one reason for strength training I recommend high-intensity training. Nonetheless, if you lift weights, it may be beneficial to add a component of high-intensity interval training.

Intermittent fasting

Nothing increases the process of autophagy more than going without food. Intermittent fasting increases the quality of mitochondria, partly through this mechanism.

The cellular and molecular effects of intermittent fasting are similar to those of regular exercise, which suggests that mechanisms are similar.

Resveratrol and other phytochemicals

Resveratrol increases lifespan in mice on a diabetes-inducing diet. One of the ways that it works is by increasing mitochondrial quantity and quality.

EGCG, from green tea extract, also improves mitochondrial quality.

Iron

The accumulation of iron causes mitochondria to become dysfunctional, and this is critical in aging. Controlling iron levels is critical to fighting aging.

Control your mitochondria or they will control you

Aging is characterized by a loss of mitochondria quality and quantity, and there’s every reason to think these are critical to the aging process.

A couch-potato life, with no hormetic stressors, leads to poor mitochondria, and subsequent aging and disease.

Therefore you must control your mitochondria or they will control you.

 

For more on how to control aging, the best few bucks you’ll ever spend are on my book, Stop the Clock.

PS: You can support this site by purchasing through my Supplements Buying Guide for Men.




Guest Post: How to Make the Most of Your Time

This is a guest post by Jennifer Landis, who writes at Mindfulness Mama. (See her previous guest post.) Jennifer is a health nut – which explains what she’s doing here at Rogue Health. When she pitched me this post, she said it was a bit “parenty”, which it is, but it’s all good.

 

Unexpected Ways to Make the Most of Your Time 

When you’re a parent, the amount of free time you have is pretty much non-existent. After all, you’re doing cooking, cleaning and laundry for more people — and the smaller that extra human is, the messier they tend to be!

You’re also on high alert pretty much round the clock, so even small tasks you used to do without thinking take at least twice as long because you’re constantly being interrupted — or at the very least, your mind isn’t fully on the job.

Five Ways to Get a Little Extra Time

This means your leisure time takes a big hit, and that could turn you into an extremely miserable person to be around. Instead of embracing martyrdom and turning into a monster, try these tips for getting a little more out of your day.

Just a little extra efficiency here and there can add up to a glorious couple hours of free time on the weekend — and maybe a little each day — if you play your cards right. Here’s how:

 

  1. Turn Tasks Into Togetherness Time 

Whether you see your kids all day or they have started school and won’t be home until mid-afternoon, you can still kill two birds with one stone in the time you spend with them. Once a day(ish), declare that it’s time to do a chore together — emptying the dishwasher, folding laundry, sweeping the floor, whatever. The job goes faster with help as long as you pick something age-appropriate, and you set the expectation that families pitch in together.

You can also have more in-depth conversations that you might think — working side by side somehow frees older kids up to start talking about things they’d never bring up at the dinner table.

 

  1. Limit Your Screen Time

For real, it’s time to talk about what a time suck Facebook is. It’s so tricky to get a handle on just how many minutes — or hours! — per day you waste on social media because you probably open up those apps for just a few minutes at a time. Maybe you’re waiting for the microwave to finish, and then suddenly your food got cold because you got sucked into a political debate.

Instead, give yourself a specific time frame for internet browsing and social media during the day — maybe 30 minutes in the morning and 30 minutes at night. When you compartmentalize, you’ll use those distracting screen a lot less and have more free time for something you really love.

 

  1. Maximize Your Time in the Car 

Whether you commute to work or just spend a lot of time playing chauffeur for your kids each afternoon, the time you spend behind the wheel — or worse, stuck in traffic — can seriously cut into your enjoyment of life. Try using that time to your advantage with some great apps that let you listen to your favorite book, learn a new language or even meditate — all hands free!

You can also record your daily to-do list or make phone calls with your Bluetooth to take care of little things while you’re stuck on the road.

 

  1. ABC: Always Be Carrying … a Book! 

You never know when you’re going to be stuck waiting in line for longer than you expected, so it’s a good idea to toss a book into your bag so you can pass the time productively. You can leverage this otherwise annoying time to enjoy yourself for a bit, or you can focus on learning a new skill.

Carry a journal instead, and you can get creative by writing your own material while you wait. Maximizing your time also means stealing some moments back for yourself, and this is easier to do when you pack appropriately.

 

  1. Learn to Say No to Things That Don’t Bring You Joy

If you’re feeling over-booked with committees and volunteer work in addition to everything else you do for your family, it’s time to start cutting back. You de-clutter your home to get rid of things you no longer need, right? You can also de-clutter your life to clear your schedule of activities and commitments that are making you crazy instead of fulfilled.

You only need to ask yourself one simple question to know if a new activity is something you should say yes to: Would you be glad to clear your Saturday to do it, right now? If not, it’s probably not worth adding to your schedule. Avoid a difficult conversation by emailing your polite regrets, and refuse to feel guilt by saying you’re going to spend time with your family instead — then do it!

By finding extra time in your day with just a few of these tips, you can breathe a little easier because you won’t be breathlessly running from task to task. Enjoy your extra time by doing something for yourself — even if it’s just a quick trip to the gym! — or by spending a relaxing afternoon with your family. You’ve definitely earned it!

PS: If you liked this article or my website in general, check out my books, Dumping Iron, Muscle Up, and Stop the Clock.

PPS: You can support this site by purchasing through my Supplements Buying Guide for Men.