Obesity, inflammation and chronic disease

Obesity is excess fat accumulation in adipose tissue due to genetics plus lifestyle factors

This results in higher levels of inflammatory cytokines and oxidative markers, which links morbid obesity, metabolic syndrome and various medical co-morbidities associated with obesity

The macrophages in the adipose tissue cause the release of pro-inflammatory cytokines

The anti-inflammatory or anti-oxidant defence system is reduced, there is reduced levels of catalase and glutathione

The Western society dietary intake and lifestyle could also increase the level of inflammation and oxidative stress and the lower intake of anti-oxidants such as vitamin C, E and Beta carotene negatively affects the oxidative balance

The emphasis of medical intervention is multi-disciplinary, based on

• Bariatric and metabolic surgery
• Healthy diet
• Regular exercise program
• Positive mind set and good social support

Losing weight by diet, exercise, medications, surgery as well as eating better and having a regular exercise program will also help to reduce inflammation and reduce risk for chronic disease associated with obesity.

Bariatric and metabolic surgery

Is the most effective way for rapid and sustained long term weight loss in patients with morbid obesity

Weight reduction can have beneficial effect on the levels of inflammation and oxidative stress and lower the risk of chronic diseases

Post op bariatric surgery diet

Selecting a healthy diet after bariatric and metabolic surgery is vital for adequate nitrogen balance, to maintain adequate macronutrients and satiety as well as prevention of fat free or lean muscle mass loss

It is recommended to have

• Adequate protein such as fish and poultry
• Moderate intake of red meat and skim milk
• Micro-nutrient vitamin and mineral supplements
• Avoiding the high GI index foods, carbs, sweets, preserved, processed/refined foods, saturated or trans fats, soft drinks and alcohol

In general it is preferable to choose natural raw or minimally processed foods and freshly made dishes

• Non processed fresh vegetables, fruits and eggs from your own organic garden homestead without chemicals, fertilisers or pesticides picked and eaten straight away is the most healthy and reliable dietary source you can find
• NOVA 1 edible plants after simple processing (dry, grind, refrigeration, freeze) aim to increase shelf life is the second best option
• Ultra processed foods are discouraged because of its high sugar, salt/sodium and fat contents as well as the synthetic or food addictive content in the food

The NOVA food classification system is

1 Unprocessed/natural or minimally processed foods

2 Processed culinary ingredients with the use of oil, fats, salt and sugar

3 Processed foods to increase the shelf life and to make the food more tasty

4 Ultra processed foods are industrial formulations made from foods (oil, fats, sugar, starch, protein), food constituents (hydrogenated fats, modified starch), synthesized in laboratories (food substrates, flavour enhancers, colours, food addictive)

The Mediterranean diet   This is an example of olive oil (mono unsaturated fatty acids MUFA), legumes, unrefined grains, fresh fruits and vegetables with moderate amount of fish (omega 3 fatty acids) as well as a small amount of red meat   It is recommended to have 100g leafy vegetables and 100g of tomatoes, these are rich in fiber, vitamins, minerals and phytonutrients It is preferable to reduce carb intake (reduce potato, corn, peas, pumpkins, squash)   Fish such as sardines, mackerel and wild salmon are an excellent source of omega 3 fatty acids   Low fat yoghurt has probiotics which are beneficial to gut health   The Mediterranean diet also includes red wine, which may have an anti-oxidant effect

The raw food diet   This is a diet consisting of Leafy green vegetables (spinach, kale, lettuce, rockets, swiss chard, water cress, collard, micro greens) Other vegetables (carrots, cucumbers, zucchini, radish, celery, bell peppers, tomatoes, broccoli, cauliflower) Fruits (apple, berries, banana, oranges, grapes, mangoes, watermelon, pineapple, kiwi fruit) Sprouts (alfalfa, bean, sunflower, broccoli, radish, lentil sprouts) Legumes (chick pea, lentil, green pea, black beans, Adzuki bean, mung beans) Nuts (almonds, walnut, cashew, Brazil, pecan, macadamia, hazelnuts) Seeds (chia, flaxseed, sunflower, pumpkin/pepita, sesame, hemp, poppy) Herbs (basil, coriander, parsley, mint) Grass juice (wheatgrass, barley grass) Oils (extra virgin olive oil, avocado oil)

Essential amino acids

These are amino acids that can’t be adequately synthesized in the body, hence they need to come from dietary sources.

The 9 essential amino acids are histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan and valine.

The food source that provides all 9 essential amino acids are called complete protein foods, which are nuts, seeds, dairy, soy, quinoa and buckwheat

The food source that contains some but not all essential amino acids are called incomplete proteins, they are beans, mushroom, cottage cheese, berries, chia seeds and wholegrains.

Essential fatty acids

Essential fatty acids can’t be synthesized in the body.

Essential polyunsaturated fatty acids include omega 3 fatty acids (alpha linolenic acid) and omega 6 fatty acids (linoleic acid) or vitamin F, for the regulation of the immune and central nervous system

Good sources of omega 3 fatty acids include

• Fish (especially salmon, mackerel, tuna, herring, sardines)
• Nuts and seeds (such as flaxseed, chia seeds, walnuts)
• Fruits (such as kiwi fruit, papaya, avocado, berries, oranges)
• Oils (include canola oil, cod liver oil, flaxseed oil, mustard oil, soybean oil, walnut oil)

Good sources of omega 6 fatty acids include

• Egg yolk
• Walnuts, almonds, cashew, pine nut
• Sunflower seeds
• Oils (such as safflower oil, sunflower oil, avocado oil, soybean oil, corn oil)

However it is recommended that you don’t over consume certain foods high in omega 6 linoleic acids (such as processed meats, potato chips, salad dressings), peanut butter and processed seed or vegetable oils

• Omega 6 fatty acids can be pro-inflammatory if the balanced ratio with omega 3 fatty acid is wrong

Anti-oxidant diet

Anti-oxidants can be synthesized in the body and are also found in certain food sources.

Anti-oxidants acts against harmful molecules such as free radicals to reduce oxidative stress

Foods that are high in anti-oxidants include

• Fruits (blueberries, blackberries, strawberries, raspberries, pomegranates)
• Vegetables (artichoke, kale, spinach, asparagus, cabbage, broccoli, lettuce, carrots, beets, okra)
• Spices (ginger, turmeric, garlic)
• Herbs (rosemary, parsley, sage)
• Drinks (green tea, pomegranate/beetroot/cranberry juice, red wine)
• Dark chocolate
• Pecan nuts

Probiotic in the diet

Probiotics are beneficial live bacteria (Lactobacillus or Bifidobacterium are the most common) with potential health benefits to the gut and body

Probiotics are usually found in

• Yoghurt
• Kefir (fermented milk drink)
• Sauerkraut (shredded cabbage fermented by lactic acid bacteria)
• Kimchi (cabbage with Lactobacillus)
• Gherkins (pickled cucumber with lactic acid bacteria)
• Miso (fermented soybean with Koji fungus)
• Kombucha (fermented black or green tea)
• Some aged cheese

Obviously patients with lactose intolerance, certain gut conditions or poor immune system should not consume probiotics without consulting with their GP or specialists

Pre and post op exercise

Adequate aerobic and resistance training exercise program is extremely beneficial to patients with obesity.

Starting in the pre-op phase to improve parameters (weight loss, reduction of fat mass), improve oxygen consumption and improve cardio-vascular fitness.

After bariatric and metabolic surgery, exercise program and fitness training increases the chances of successful long term weight loss and more importantly preserve the lean muscle fat free mass as well as help to prevent bone demineralization.