[ MUSIC PLAYING] Hello, and welcome to theUniversity of Chicago Medicine At the Forefront live. The purpose of ourprogram is to allow you to interact with ourdoctors live on Facebook. So get your questionsready, and we’ll answer as many as we possiblycan over the next half hour. Now, we want to remind ourviewers that our program today is not designedto take the place of a medical consultationwith your specialist. Joining us today is Dr. EdwinMcDonald and Dr.Christopher Chapman. They’ll be speaking with usabout healthful weight loss options available hereat UChicago Medicine. I’ll start off with the twoof you innovating yourselves. Kind of tell us a little bitabout your areas of specialty. Absolutely. So I’m one of theadvanced endoscopists here at theUniversity of Chicago. There’s three of us here. So I do a lot of procedures thatdeal with pancreatic cancer, other maladies like that. And one of my focuses ison endoscopic managements for obesity. And that’s what I like to do. Great. Dr. McDonald? So I’m also one of thegastroenterologists now. I specialize in nutrition. So that makes Ibasically determine people who suffer from malnutrition. So people withshort bowel disorder who need alternativeways to get nutrients in. And I likewise do weight management. So I too do someof the procedures that Chris mentioned, but alsofocus on medical weight loss, which is essentially talkingabout diet, practise, and then people who qualify maybeeven exploiting medications.And you’re also a cook. We’re going to talk a littlebit more about that last-minute. I’m likewise a studied cook. That’s pretty exciting. That’s great nonsense. It is. I desire doing it. I haven’t had hisfood yet, though. Really? Well, I should haveyou over sometime. I think so. I think so. I think that’s anofficial invitation. Yeah, that was an invite. We have a witnesshere, so that’s great. You heard it here now. Absolutely. Well, countless peoplehave had their lives reformed the healthyweight loss options available at UChicago Medicine.Let’s hear from oneof our patients, who had a wonderful outcome. I marched from my apartmentto the lake and back. And that was somethinglike 6,000 gradations. And you know, it’s not somethingI could have done a year ago. So I’m really happy about that. I’m happy. My wife’s happy. Everybody’s happy. Gregory Fulham isdoing things he hasn’t been able to do in years. The success has been startling. Gregory had aprocedure performed by Dr. Christopher Chapmancalled endoscopic sleeve gastroplasty. The procedure isquick, and the research results can change life-times dramatically. The advantages ofthe endoscopic sleeve gastroplasty are that it’san outpatient procedure. There is a lack of incisions, so there is no scarring. And the healing timeis drastically reduced. The endoscopicsleeve gastroplasty is a noninvasiveprocedure designed to reduce gastric publication. Sutures are put inthe stomach, reducing the size of the stomach. Stomach volume isreduced by 50% or more.Patients chew less, becausethey become full more quickly, and are satisfiedwith smaller components. You feel full sooner. And that’s a good thing. The University ofChicago Medicine stipulates a full rangeof bariatric assistances. For some cases, thisis the perfect solution. Others, though, willrequire surgical procedures, likewise available at theUniversity of Chicago Medicine. We’re happy to seeany patient who would be interested inprocedures or other methods for weight loss. However, for this particularendoscopic sleeve gastroplasty procedure, we’relooking for patients who are really in needfor that jump start to lose about 30 to60 pounds of load. Patients go through aprocess before such procedures to make sure they’reready for this step. After such procedures, they will be expected to changetheir lifestyle, dining less and exercising more. At University ofChicago Medicine, we respect ourselves on ourmulti-disciplinary evaluation. That includes seeinga psychologist, an endocrinologist, adietitian, as well as a gastroenterologist. We have the patients view allthese providers before we even do the procedure.Gregory says theprocedure went very well, and the changes tohis lifestyle have been astonishingly easy to start. I eat the same stuff thatI have been eating forever. I only eat less. The procedure had Gregory in andout of the hospital in a daylight. He says the care has fucking awesome. It’s really a privilege tobe in a neighborhood that has an institution like this sohandy and so ready to assist. It’s wonderful.See, that was I thinkpretty interesting, because it genuinely showedwhat a difference that established in Gregory’s life. I convey, he was talking aboutthese changes, and the fact that he can walkand get around now. Which is really neat to see. Absolutely. He’s had a remarkable journeying. And you know, hekeeps telling me– I watch him where he isemployed– and he tells me how much of a differenceit’s made for him. Great. And Dr. McDonald, I imagine you ascertain a lot of cases thatare in the same situation, where their lives areliterally altered. Oh, unquestionably. I represent, I’ve seen people– I study the most weight lossI’ve seen in our clinic so far maybe extended probably closeto 150 pounds or so. So that makes a hugedifference in people’s lives, as far as mobility, as far as happiness, as far as only day-to-day, everyday interactions. So I know both of you are– what you preach to yourpatients is healthy weight loss, and healthy is theimportant aspect of that.Let’s just start off talkingabout which is what that signifies. What’s the differencebetween health weight loss versus non-healthy weight loss? So for me, I thinkit’s better to define what undesirable weight loss is. And that’s a goodplace to start. So undesirable weight loss– you know, I attend a great deal of peoplewho try these starvation diets. So these various fasts, where people are just drinking water for periods on end. And a good deal of those nutritions, it’sreally merely not sustainable. So I think healthyweight loss is something that is going to havea sustained consequence over time. And it is a pattern of eatingthat someone can actually stick to and continues its, as opposed to something that is going to lead to issuesover a certain period of time.So there’s a lot of differentvery, very low calorie diets out there that for the mostpart will lead to weight loss. But you can really merely dothose for about a month or so. And eventually, mostpeople, all the weight is going to come back. So what we tend tofocus on is really a practice of munching thatpeople can carry out throughout their entire life, as opposed to merely 1 month or just a couple of months. Because again, like I said, we want the weight loss to be sustainable.It’s a lifestyle change. Yeah. I concur. And as Ed and I weretalking together– we work very closely together–that this is not just a single instant of change. This is a lifestylechange that we want to do. And that’s why themulti-disciplinary approach that we encounter withEd working on some of the medicationsand the procedures that we do together, where thefocus is more about equipping stability for those working patientsthat yo-yo up and down with their heaviness. Since they are do a fad diet. They hurtle. And they get down, but thenit’s ultimately unsustainable. And then they end up havingthese problems again. So we’re trying to findthese ways to build is not simply a medical tie-in, but a personal relationship that allows us to makelong term reforms. And when people yo-yolike that, it’s not only hard on them physically, but emotionally as well, I would imagine. Yeah. And it’s actually harderto maintain the weight loss when you go up and down. Primarily, every timeyou go up and down, that’s associatedwith hormonal modifications. And that can impact your longterm weight loss overall.So the highway I view weight loss, it’s almost like a pyramid. And you have tohave the foundation. Without the foundation, the whole pyramid is going to fall apart. But there will be maybemultiple rings on the pyramid or calls on the ladder. So lifestyle modificationis really the foundation. But for a great deal of people–for most people– studies is demonstrating that lifestylemodification on its own may not be as effective. And that’s why weprovide these adjuncts. And so “youve had” medications. You have bariatric andendoscopic rehabilitation. Then we also havebariatric surgery. And each of them canplay an important role, will vary depending on what the individualpatient is going through. Full continuum of care here. A full continuum of care. Great. I wishes to be prompt our viewersthat if you have questions for either one ofour specialists, exactly character him in on Facebook, and we’ll get to him as quickly as we can.We have our firstquestion from a see. And that is, is BMI the bestway to gauge a healthful weight? So BMI is the waythat we use customarily mainly because forresearch intents, we do have to have somesort of classification, and likewise to decidewhether or not people would benefitfrom bariatric surgery or remedies. We need some kind of markerto originate those decisions, and BMI located upon studieshas become that marker. But there are alot of limitations when it comes to BMI. So BMI is not a reflectionof your muscle mass , nor is it a reflectionon differences in terms of ethnicity. So particular ethnicitiesmay exactly in general carry a higher BMIor a lower BMI. So for instance, accordingto research studies, beings of Asian descent mayhave a lower BMI to begin with.But that does notnecessarily mean that they don’t have obesity. So someone may not havea BMI that leans them in overweight category. But if you actuallylook at their fat mass, technically they’refunctionally over load. And BMI is not capturingthat person. So BMI is just onemetric that we use. But it’s not the solemetric, by no means. We look at other things, like waist circumference. Things like that. Or also we really look for likekind of visceral adiposity, or solid volume we’retalking about. So I agree with Edthat BMI in itself is not the only toolthat we use and should be using to assesssomeone’s weight status. Great. We have another questionfrom a spectator that requests, how do you know if youshould be considering bariatric surgery orendoscopic procedure or something else likemedical weight loss? And I’m going to throwthat one to you first.Sure. So since we have thewide spectrum of care here going all the wayfrom lifestyle management to medications tobariatric endoscopy all the way up to bariatricsurgery, what we try to do is work very closely withthe whole group to decide what’s the best for thepatient individualized. And so our general guidelinesare based on a BMI. So if you have a BMIbetween 30 and 40, that might perform youa good candidate for endoscopicbariatric therapy. Nonetheless, if you havea BMI greater than 40, oftentimes bariatric surgeryis the most effective option to treat your obesity question, aswell some of the complications that arise fromthe weight controversies. And so either a BMI greater than4 0 or a BMI of greater than 35 with co-morbidities shouldbe considered for surgery. However, if you look atmedications, even a BMI of 27 would be an indication toconsider medical management to help with force. So we can use the BMIas a starting point. But then we do tailorit to individuals.So if someone has a BMIin a higher class that is more interested inendoscopic procedure, that may be betterthan nothing at all. it actually dependson the patient. But we kind of use the BMIas a first starting point. And Ed, how do “youre feeling”? Yeah, I thoroughly agreeAnd what Dr. Chapman here conveys by co-morbiditiesis really the other conditionsthat may be associated with win extra value, or merely other conditions in general. So say someone hassevere lung cancer. That may set them atrisk for complications from bariatric surgery. We may have to consideralternate alternatives that aren’t as invasive. Or if someone hassevere diabetes and we know they need tolose weight immediately, bariatric surgery maybe the better option, just because we know it’s alittle bit more effective, particularly with a BMI over 40. And I believe Ed bringsup a great point about the timing and the need. So we deal atUniversity of Chicago with a lot of patients withsignificant health problems in addition to weight publishes. And so we’re inconstant communications with our displace surgeons, our orthopedic surgeons, our OBGYNs.We deal with fertility issues. These are the individuals who, ifthey’re struggling with these conditions, sometimes helpingthem lose a little bit body weight– even 10% — can make asignificant difference for their outcomesfor other procedures or their plans fortheir families. I’ve got to get toa couple of things, because we have someprops now that you fetched that I’m fascinated by. And so if you couldkind of explain to us what we’re seeing here. And we were talking a littlebit during the video that aired a few momentsago, and there was an animation that showedone of such procedures you do. And you brought in some things. Right. So currently, there areabout three procedures that are FD-Aapproved, or thedevice is FD-Aapproved for use. And these areendoscopic procedures, meaning that we use a flexibletube with a camera on it to go down through themouth and do interventions on the stomach. So there’s no cutsor no openings. The weave healingis not really there, because it’s all internal. It’s very discreet.And so these are theoptions that we’re kind of employing fromthe endoscopic side. And there’s theintragastric bag here. You see it’s a silicone balloon. There are about three that areFD-Aapproved on the market. They’re fluid-filledor gas-filled. They’re about thesize of a grapefruit. They remaining in your gut fora interval about six months, and then we take it out. So this is a very niceoption for those patients who are looking for avery reversible alternative. Because once youremove the balloon, you’re completelyback to yourself. The other option that wedo is the endoscopic sleeve gastroplasty.This is a where we usea suturing manoeuvre here that allows us to actuallytake full thickness bites through andthrough the belly wall to tighten the gut. And we kind of announce thisthe accordion procedure, because you’re mostly foldingit and closing it on itself. And this is the onethat Gregory had and had such a great response. So you can see that you usethis device and a handle that allows you to close andbasically pass a suture and take gnaws of material. And then I’ll let Edhere finish and talk about aspiration therapy. Because we both dothis therapy here. Yeah. So there is aspirationtherapy, which is basically where we placea small tube in the belly. And the tube allows peopleto empty out at least 30% of their calories thatthey take in a granted meal.So you know, it’sactually exactly a variation of a common procedurethat we do all the time as gastroenterologists, whichis a Percutaneous Endoscopic Gastrostomy tube, alsoknown as a PEG tube. So generally historically, we do the PEG tube for people who can’t dine. They have immersing issues orissues with their esophagus, and “were supposed to” feed themdirectly in the stomach. But with this tube, It’sa little bit different. So this allows peopleto mostly empty out their stomach really a little. But one, you have to chewyour meat very carefully. So you just can’t empty outeverything you’re eating. Two, it’s always done in acontext of life-style alteration. So it’s not a tool thatpeople can use and only eat whatever they want andempty whatever they want. Doesn’t work precisely like that. So people are participated bymyself and our dietitians, and even “were having” psychologistsinvolved that help us out with the whole process. You know, that to meis I recall critical.Because this isn’tjust a procedure. When you both do yourwork, you involve a great deal of kinfolks in the process. And it is about alifestyle change. It’s really from beginningto end with them. Right. You need a fullevaluation for this. Because it is sucha drastic alter. A quantity of experience, parties arebattling 30 -4 0 years of attire that they’ve builtup that they’re trying to suddenly change.And kudos to them for comingin and starting that process. But because it isso challenging, we acknowledge that we haveto ask our patients to meet with a dietitianand a psychologist to make sure that we’removing in the right tendency and it’s going to be safe. Great. Now we have a questionfrom one of our viewers. Stephanie is asking, shesees every one or two years there’s a new faddiet that comes out. I speculate keto, Whole3 0, paleo, there’s a bunch of them.Are these reasonable forpatients to do diets like this? Does it help? Is this more of a interference? What are your thoughts? I make, everyone’s alittle bit different. And I recollect whenever wesee someone in clinic, we don’t automatically tellthem time to do Keto, or said about precisely to do x diet. We genuinely have to takean individual approach to understand what people’staste wishes are, what their ability toafford specific foods, where they live at. So access is an issue.So we take all these differentthings during its consideration. But what a great deal of thesediets have in common, ultimately you’re avoidingultra-processed foods. So there’s no diet thatreally tells you to eat a entire bunch of potato chips. Or other nutrients. Or other ultra-processed foods. And then most of the dietsreally involve some sort of calorie restriction. So there’s a lotof debate out there in terms of where we shouldplace those calories. Should those caloriesbe mostly protein? Should those calories be lessfat or less carbohydrates? But when you look at alot of different studies, ultimately when peopledecrease their caloric intake– their calorie intake–people tend to lose weight. And if you addexercise to the mix, you’re even going tolose even more force. So basically, exactly eating fewer and chewing more healthierfoods that aren’t managed is going to be the foundationto any of these diet programs.Now, there are some nutritions outthere that are just unsafe. And the majority of members of thosediets are really where you’re doing like8 00 calories or less for extended periodsof time, where you’re place yourself at riskfor starvation and likewise protein loss. So you know, Itend to tell people to be careful withthose, and also be careful withthings that sound like it’s toomiraculous to be true. So if there’s a nutrition thatsays the supernatural diet, the supernatural dietreally were not available. And if the nutritions reallyjust places great importance on complements, typically a lot ofsupplements don’t really lead to a lot of weight loss. So case in point, there’s like the HCG diet out there, wherepeople are taking a lot of HCG, which is a hormoneassociated with pregnancy.You know, that diet has been– it’s out there inthe literature. But the diet has beenstudied, and it’s not as effective as whatpeople claim to be. So eventually, what I tellpeople with these nutritions, you really have todo your research. And a lot of researchshould include talking to a registered dietitian. Not necessarily a nutritionist. If they are anutritionist, you really have to find someonewho’s licensed, as opposed tosomeone who is online claiming to be a nutritionist. Which that happens. We have another viewer who– there’s a procedure that theyhad done called the roux-en-Y. Is that correct? Roux-en-Y. Gastric bypass. Yeah, it didn’t maintain. But they want a new start. What would you tellsomeone like that? Right. We envision a good deal of patients whohave had bariatric surgery, and then unfortunatelyhave recaptured force. So I mull when we bring theminto our clinic to discuss, we really exactly try to findthe underlying reason why they’ve had value regain.Is it something behavioral? Or is it something mechanical? And if it’s mechanical, sometimes we can actually try torepair those things. The restore “couldve been” surgical. So bariatric surgerydefinitely has a role, like a revisionbariatric surgery. But also we’re employ thisendoscopic suturing device to do certain things as well. So a good deal of durations, wefind that the opening of the gut to thesmall intestine is distended. So it’s stretched outin size over time.And this typically happensanywhere from five to eight years post-operative. And you can actuallyuse this design to suture down that opening tomake it tight again to provide that level of regulation. So one of the keyquestions I ask my patients when they come in withthis problem is, do you feel any restriction? Or can you eat more foodthan you could before? And so those aredifferent things that we want to tryto get at to try to see if maybe there’s amechanical component that can be doing this. And even sometimespeople may form what we call a gastrogastricfistula, where there’s actually an abnormal connectionfrom their pouch into their age-old eliminated tummy. Because with a bypass, yourold stomach is still here. So there’s a chance, actually, when you snack, the food you’re going isback down the original path.And so we kind of do afull scope of evaluation to see is there’ssomething mechanical, or is theresomething behavioral? And “theres going” from there. Dr. McDonald, can we talkabout coffee a minute? I’m pointing at yourUChicago Medicine pot. I’ve got to getthe plug in there. But talk a littlebit about chocolate, because we were discussingthis a little bit before the programbegan, and some of the benefits of black coffee. So conduct us down thatpath, if you are able to. I represent, for me, I’m probablya coffee admirer since several years ago when I became a residentand had my firstly kid– my bride and I first kid– when I was an intern. So coffee is compulsory. And since then, Ijust have not stopped. Overall, coffeeis pretty healthy. So there’s a great deal of concerns. A spate of times parties comein to me and in my clinic and say things like, I stoppedcoffee, I stop spicy menus. And I’m like, waita instant, where did all this negativeconnotation come from when it comes to coffeeand spicy meat and substance like that? Because eventually, a lotof these meat are healthy.So black coffee by itselfhas been associated with decreased riskof liver cancer, and maybe even decreasedrisk of myocardial infarction. Now, when you contribute a lot ofsugar and a great deal of ointment some of the fancylattes and everything that have a lotof calories, that can be associatedwith weight loss. And also, thosearen’t very healthy, because it’s againsimple sugars. And that’s probably more alongthe lines of the processed food category. So there are somerecent concerns about coffee and cancer. Specific in thestate of California, at least at Starbucksand other coffee collects, they have to set a labelexplaining the risk of cancer with certain types of coffee. So a lot of that risk ora lot of those concerns comes from studieson mice, but not necessarily studies in humen. So most of thestudies in humans, again, is demonstrating that coffeedecreases the hazards of cancers. But issues of concern truly comesfrom the fact that chocolate, extremely when it’s roasted–so like our darker roasted coffee– may have higher extents of acarcinogen– a cancer motiving agent– announced [? acro ?] aromatase.But that’s alsofound in potatoes. It’s also found in bread. It’s also foundin a lot of foods that we roast in the oven. Now ultimately, howmuch does it take? You know, how much exposureto [? acro ?] aromatase does it take to cause cancer? I don’t thinkanyone truly is recognized that, because to set that upto answer that question, you’d have to do an unethical study, where you’re just hand parties [? acro ?] aromatasefor many years and then looking what happens. So we don’t know. But ultimately, I booze coffee. I probably booze maybe alittle bit little dark cook. But I don’t really haveany concerns about it, for my own well-being. One of the questionstoo that’s coming in kind of along the samelines, and it deals with cancer. But the link betweenobesity and cancer. Would either one of youcare to comment there? Right. I represent, so there’s definitely alink between obesity and cancer as well as outcomes relatedto cancer cares. If you look at breastcancer, for example, that there have beenplenty of literature published and well-donestudies suggesting that if you have obesityand are undergoing treatment for breast cancer, that youroutcomes are less favorable.So we know that thereis definitely a tie-in not only to thedevelopment of cancer, but likewise to the outcomesrelated to therapy. So this is another reason whyI think some of these options should be on thetable for patients, even when they’re battlingsome of those very strenuous states. Interesting. So a few questions. Many of these favourite dietsor high protein diets.And the concern is, is there a correlation between all that protein andpossibly having kidney stones? Not consequently. So it depends on one, someone’s personal history with kidney stones. Because there’smultiple different types of kidney stones. Most of the stones are reallybased upon calcium , not undoubtedly protein intake. Now in the past, especiallylike in the’ 90 s, everyone was concerned about eating toomuch protein and that generating kidney downfall. So I retain yearsago when I was playing football and boasts, and parties is attempting to do protein shakes. And all the coach-and-fours werelike, don’t do too much, or else you’re goingto get kidney failure.That is not true. So that has all been debunked. And a great deal of people– evenpeople with kidney disease– actually need protein, up until a certain point where they need dialysis. Then “youve been” simply needto talk to a dietitian and make sure you’renot overdoing it. But for the most part, the protein concerns and kidney disease, “youve been” don’t have to be concerned too much. Because most people aren’t goingsuper crazy with the protein. Another one of ourviewers says, I have a PCOS and aslightly high-pitched A1C. Would an endoscopic weightmanagement procedure be beneficial tohelping me lower my A1C? Yeah, I think that’sa great question.Unfortunately, one of thecommon lectures of PCOS is weight-relatedchallenges in addition to menstrual cycleirregularities or having erratic spans. And so the care of PCOS orusing an endoscopic control, it truly gets tothe bottom line is, does it alsohelp with treatment of those conditions thatare associated with weight, such as diabetes orhigh blood pressure? And there areliterature out there that therefore seems that theseendoscopic procedures, when they’re capable to lose that1 0% to 20% of your load, can improve hemoglobin A1C, canimprove people with fatty liver illnes, can improve people withblood pressure or cholesterol troubles. So yes, for thatperson out there, I would say thatif you do have PCOS and you’re strugglingwith weight, this could be a viable optionto help you get over that mound and get you out of that. We verify a lot of patients whoare in that pre-diabetes phase, and they say theirnumbers are borderline.If they’re trying tocorrect the above issues, weight loss will help tryto get them back down out of that assortment. So parties with that borderlinediabetes, that’s a signal. That’s an alarm signthat’s just going off saying that we need probably todo something more aggressive. Whether that’s lifestyle, whether that’s endoscopic, whether that surgery isvery accommodated to the person. But that’s an alarmsign for parties. Because these things can help. Can I answer that? Yeah, absolutely.So also, PCOS canbe very complicated. And it’s somethingthat really requires a multi-disciplinaryteam to manage. So now at theUniversity of Chicago, “were having” people seeingendocrinologists. We work with the gynecologists. And then we alsowork with ourselves as weight loss specialistand endoscopist. So I think that approach isgoing to be individualized. But it’s probablygoing to take input from a lot of differentdoctors to decide what’s the best overall approach.Absolutely. Because there aremedications that are great treatmentsfor PCOS extremely. Like a good deal of patientsare on metformin, which also is an a bloodsugar self-control remedy. So that may be enough tohelp this person get out of that range with amildly heightened A1C. So as Ed mentioned, we work very closely with the endocrinologistto make sure that they’re inthe right approach. We don’t time offerone thing and say that this is what we do.But you have to lookat the whole picture. And sometimes, proceduresaren’t the privilege option. Sometimes prescriptions are. But we do tailor itindividually, I would say. Another viewer question. I’ve heard that women’shormones make it more difficult to lose weight. Would you approach a woman’sweight loss therapy differently thanyou would a gentleman? No. I represent, for the most part, yes. So gals can have a hardertime to lose weight. But at the end, truly, life-style revision is the foundation. And those modifies are the same. Reducing calories, trying to exercise, sleeping , not tryingto sleep too little , not sleeping too much. And then from there, we decidebased upon other conditions people may havewhether or not they’re potential candidates for bariatricsurgery, medications, or endoscopy. But ultimately, theequation, if you will, is relatively same. It just so happens to be alittle bit more difficult, especially in women whoare post-menopausal.Yeah. We hear a lot of womenpatients actually come in who are interestedin endoscopic cares. And in fact, ourmost frequent patient are really those cases thathave had their second child, and they just can’tshake the load after their secondor third child. And so there is definitelya gender difference that I’ve seen in my practicein terms of how people do. But lovers do wellwith the procedures and with lifestylechanges as well. But I think it is somethingthat we do try to tailor. And we look at other thingsthat they’re going through. Females may be more likely tohave thyroid cancer than a man. So we have to ask thosekinds of questions and make sure those conditionsare ascertained or assessed as well.And so there are other thingsthat we look at same time. A few questions from a witnes. Vegan diet, yes or no? Yeah. I want, it depends onyour taste penchants and what you’re really into. So if you just wanted to do fruitsand veggies and has become a vegan, you can do thatin a healthful path. But you really haveto be a healthful vegan. So I’ve seen unhealthyvegans where, they’re just eatingpotato chips, and they’re callingthemselves a vegan. And technically, you canbe on a potato chip diet and has become a vegan. But that is an harmful food. Or you could just eat pastaall day and be a vegan, but you’re not eatingfruits and vegetables.So I remember I was givinga community lecture, and someone came up to meand said they’re a vegan. And I asked them like, oh, what’s your favorite fruits and vegetables? And they said, they hatefruits and vegetables. And I’m like, howcan you be a vegan and you hate fruitsand veggies? So that is an example ofbeing an undesirable began. But vegan as a whole, a lot of studies show that parties maylive a little longer, if you look at some of theSeventh Day Adventist studies. They are eligible to havea decreased risk of cancer. So for some people, thatis a terribly viable alternative. People who are interestedin becoming a vegan, you have to be aware of thepossibility of B12 deficiency. So that’s somethingthat obviously occurring in the vegan person. But outside of that, youreally really have to make sure you’re a health, whichapplies to any diet. And I would imagine you justhave to watch your intake of– Yeah, the macronutrients. Building sure you get a protein. What are the protein sourcesthat are vegan-compatible.Those are why you see aregistered dietitian or someone like Dr. McDonald whocan help you understand what those macronutrients– What is a good proteinsource for a vegan, just out of curiosity? So you’d have to havemultiple protein informants. Primarily because there area few plant-based proteins that has already been youressential amino acids. So the only ones Ican think of offhand, quinoa is a completeprotein that’s plant-based. And I guess amaranth is also. But everythingelse, you’re going to have a combinationof different seeds, different nuts, anddifferent beans. And exerting thatcombination will get you all those essentialamino battery-acids, which are kind of the buildingblocks of protein. We’re about out of time, butwe do have one more question from one of our viewers.Keto diet, good or bad? It can be good ifdone appropriately. So a lot of studiesshow that the keto died for peoplewho have convulsions can decline therisk of seizures. It plays a rolein it, especially in people who have epilepsy. It may help out withpeople who have migraines. And people can lose weightwith a ketogenic food. Now, the ketogenic diet is stilla relatively recent phenomenon, so in terms oflong term accomplishes, I is necessary to do alittle bit further studies.In periods to seeing how itaffects our bowel bacteria, those studies alsoneed to be done and are actively being done. And I think someof our investigates, solely Jane Chang islooking at some of those, trying to answer someof those questions. But from a weight lossperspective exclusively, people can lose weightwith a ketogenic nutrition. But at the end of theday, most of these foods are genuinely restrictingyour calories, and actually trimming back on someof these ultra-processed foods. Dr. Chapman, anyparting oaths for us? No. I think this was fantastic. I hope everyone learned a lot.And you know, I hope you gota taste of how Ed and I work very closely together, and thatwe are here to help people. And if you have anyquestions, we’re always happy to reach out. Definitely. Perfect. And we want to stressthe continuum of attention. Because there are a lot ofservices that have existed now at UChicagoMedicine for tribes that want to lose weightand vary your lifestyle in a safe form. Yeah, utterly. So I experience beings witha bariatric surgeons. For people who are candidatesfor bariatric surgery, I tend to at leastrecommend they have a conversation witha bariatric surgeon, just so they can seewhat their options are. Absolutely. Great. If you want moreinformation about UChicago Medicine’s weightmanagement platform, please visit our website siteat UChicagoMedicine.org/ load management. It’s there at thebottom of the screen. Or you can call 888 -8 24 -0 200. Thanks for watchingAt the Forefront live, and have a great week ..