[ 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 healthy weight loss options available hereat UChicago Medicine. I’ll start off with the twoof you inserting 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 now. So I do a lot of procedures thatdeal with pancreatic cancer, other illness like that. And one of my focuses ison endoscopic treatments for obesity.And that’s what I are happy to do. Great. Dr. McDonald? So I’m also one of thegastroenterologists now. I specialize in nutrition. So that wants Ibasically recognize people who suffer from malnutrition. So parties withshort bowel ailment who need alternativeways to get nutrients in. And I too do weight administration. So I likewise do someof the procedures that Chris mentioned, but alsofocus on medical weight loss, which is essentially talkingabout diet, practice, and then people who qualify maybeeven expending remedies. And you’re likewise a chef. We’re going to talk a littlebit more about that later.I’m also a civilized chef. That’s pretty exciting. That’s great substance. It is. I love doing it. I haven’t had hisfood hitherto, though. Really? Well, I should haveyou over sometime. I was just thinking. 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 converted 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 are familiar with, 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 spectacular. Gregory had aprocedure performed by Dr. Christopher Chapmancalled endoscopic sleeve gastroplasty. The procedure isquick, and the research results can change souls dramatically. The advantages ofthe endoscopic sleeve gastroplasty are that it’san outpatient procedure.There are no openings, so there is no scarring. And the healing timeis drastically reduced. The endoscopicsleeve gastroplasty is a noninvasiveprocedure designed to reduce gastric magnitude. Sutures are put inthe stomach, reducing the size of the stomach. Stomach volume isreduced by 50% or more. Cases devoured less, becausethey become full more quickly, and are satisfiedwith smaller portions. You feel full sooner. And that’s a good thing. The University ofChicago Medicine supplies a full rangeof bariatric services. For some patients, 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 hop start to lose about 30 to60 pounds of value. Cases go through aprocess before the procedure to make sure they’reready for this stair. After the procedure, they will be expected to changetheir lifestyle, eating 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 encounter allthese providers before we even do the procedure. Gregory says theprocedure went very well, and the changes tohis lifestyle have been surprisingly easy to reach. I munched the same stuff thatI have been eating forever. I simply eat less. The procedure had Gregory in andout of the hospital in a period. He says the care has fucking awesome. It’s really a liberty 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 certain differences that acquired in Gregory’s life. I intend, 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 travel. And you are familiar with, hekeeps telling me– I realise him where he isemployed– and he tells me how much of a differenceit’s made for him. Great. And Dr. McDonald, I imagine you encounter a lot of patients thatare in the same situation, where their lives areliterally transformed.Oh, emphatically. I convey, I’ve seen people– I mull the most weight lossI’ve seen in our clinic so far maybe proceeded 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 exactly 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 makes. What’s the differencebetween healthful weight loss versus non-healthy weight loss? So for me, I thinkit’s better to define what unhealthy weight loss is.And that’s a goodplace to start. So harmful weight loss– you know, I look a lot of peoplewho try these starvation diets. So these various fasts, where people are just drinking water for daytimes on end. And a lot of those diets, it’sreally precisely not sustainable. So I think healthyweight loss is something that is going to havea sustained aftermath over period. 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 foods 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 road of snacking thatpeople can carry out throughout their entire life, as to report to only 1 month or merely a couple of months. Because again, like I said, we want the weight loss to be sustainable. It’s a lifestyle change. Yeah. I agree. And as Ed and I weretalking together– we work very closely together–that this is not just a single moment of change. This is a lifestylechange that we are intending to do. And that’s why themulti-disciplinary approach that we insure withEd working on some of the medicationsand the procedures that we do together, where thefocus is more about providing stability for those patientsthat yo-yo up and down with their weights.Because they do a fad diet. They gate-crash. And they get down, but thenit’s eventually unsustainable. And then they end up havingthese problems again. So we’re trying to findthese ways to build is not merely a medical affair, but a personal relationship that allows us to makelong term modifications. 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 varies. And that can impact your longterm weight loss overall. So the course I consider 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 rungs on the pyramid or rings on the ladder. So lifestyle modificationis really the foundation. But for a lot of people–for most people– studies show that lifestylemodification on its own may not be as effective. And that’s why weprovide these adjuncts. And so you have remedies. You have bariatric andendoscopic regiman. Then we also havebariatric surgery. And each of them canplay an important role, depending on what the individualpatient is going through. Full continuum of care here. A full continuum of attention. Great. I do want to remind our viewersthat if you have questions for either one ofour physicians, simply character him in on Facebook, and we’ll get to him as quickly as we can.We have our firstquestion from a onlooker. And that is, is BMI the bestway to determine a healthful weight? So BMI is the waythat we use usually chiefly because forresearch roles, we do have to have somesort of classification, and likewise to decidewhether or not parties would benefitfrom bariatric surgery or prescriptions. We need some kind of markerto construction those decisions, and BMI based 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 specific ethnicitiesmay just in general carry a higher BMIor a lower BMI. So for example, accordingto research studies, people of Asian swoop 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 situates them in overweight category. But if you actuallylook at their fatty mass, technically they’refunctionally over weight. And BMI is not capturingthat population. 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 overweight magnitude 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 observer that asks, 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 two are. Sure. So since we have thewide range of care here going all the wayfrom life-style managers to drugs 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 is likely to build youa good nominee for endoscopicbariatric regiman. However, if you havea BMI greater than 40, oftentimes bariatric surgeryis the most effective option to treat your obesity issue, aswell some of the complications that arise fromthe weight topics. 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 weight.So we can use the BMIas a starting point. But then we do tailorit to people. So if someone has a BMIin a higher class that is more interested inendoscopic procedure, that may be betterthan nothing at all. it really dependson individual patients. But we kind of use the BMIas a first useful starting point. And Ed, how do you feel? Yeah, I thoroughly agreeAnd what Dr. Chapman here wants by co-morbiditiesis really the other conditionsthat may be associated with profit extra value, or exactly other conditions in general. So say someone hassevere lung malady. That may put 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, simply because we know it’s alittle bit more effective, especially with a BMI over 40. And I review 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 controversies. And so we’re inconstant communication with our transplant surgeons, our orthopedic surgeons, our OBGYNs. We deal with fertility controversies. 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 created that I’m mesmerized 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 the 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 incisions. The meander 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 balloon now. 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 span about six months, and then we take it out. So this is a very niceoption for those patients who are looking for avery reversible option.Because formerly 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 invention now that allows us to actuallytake full thickness chews through andthrough the gut wall to tighten the stomach. And we various kinds 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 burns of tissue. 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 stomach. And the tube allows peopleto empty out at least 30% of their calories thatthey take in a returned banquet. So you are familiar with, it’sactually only 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 frequently historically, we do the PEG tube for people who can’t munch. They have immersing issues orissues with their esophagus, and there is a requirement to feed themdirectly in the tummy. But with this tube, It’sa little bit different. So this allows peopleto mostly empty out their tummy simply a little. But one, you have to chewyour menu very carefully. So you just can’t empty outeverything you’re eating.Two, it’s always done in acontext of life alter. So it’s not a tool thatpeople can use and really eat whatever they miss andempty whatever they miss. Doesn’t work accurately like that. So beings are attended bymyself and our dietitians, and even “were having” psychologistsinvolved that help us out with the whole process. You know, that to meis I contemplate critical. Because this isn’tjust a procedure. When you both do yourwork, you involve a lot of folks 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 reform. A lot of experience, people arebattling 30 -4 0 years of habit that they’ve builtup that they’re trying to unexpectedly deepen. 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 direction 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 envisage keto, Whole3 0, paleo, there’s a bunch of them. Are these reasonable forpatients to do nutritions like this? Does it facilitate? Is this more of a drawback? What are your thoughts? I necessitate, everyone’s alittle bit different. And I judge whenever wesee someone in clinic, we don’t automatically tellthem exactly to do Keto, or said about just to do x diet. We genuinely have to takean individual approach to understand what people’staste preferences are, what their ability toafford specific menus, where they live at.So access is an issue. So we take all these differentthings in consideration. But what a lot of thesediets have in common, ultimately you’re avoidingultra-processed foods. So there’s no diet thatreally tells you to eat a whole knot 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, eventually 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 heavines. So basically, merely snacking fewer and munching more healthierfoods that aren’t processed is going to be the foundationto any of these diet programs. Now, there are some diets 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 arrange yourself at riskfor starvation and too protein loss. So you know, Itend to tell people to be careful withthose, and too be careful withthings that sound like it’s toomiraculous is correct. So if there’s a diet thatsays the miracle diet, the supernatural dietreally does not exist. And if the foods reallyjust places great importance on complements, commonly 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 food has beenstudied, and it’s not as effective as whatpeople claimed responsibility for. So ultimately, what I tellpeople with these nutritions, you really have todo your research. And a lot of researchshould include talking to a registered dietitian. Not inevitably a nutritionist. If they are anutritionist, you really have to find someonewho’s verified, 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 miss a new beginning. What would you tellsomeone like that? Right. We check a lot of patients whohave had bariatric surgery, and then unfortunatelyhave retrieved force. So I anticipate when we bring theminto our clinic to discuss, we are genuinely precisely try to findthe underlying reason why they’ve had weight regain. Is it something behavioral? Or is it something mechanical? And if it’s mechanical, sometimes we are capable of try torepair those things. The restore could be surgical. So bariatric surgerydefinitely has played a role, like a revisionbariatric surgery. But also we’re utilize thisendoscopic suturing device to do certain things as well. So a lot of times, wefind that the opening of the stomach to thesmall intestine is dilated. So it’s stretched outin size over age. And this typically happensanywhere from five to eight years post-operative. And you can actuallyuse this maneuver to suture down that opening tomake it tight again to provide that level of limited. 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 ingredient that can be doing this.And even sometimespeople may model 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 continuing. So there’s an opportunity, actually, when you chew, the meat you’re going isback down the original move. And so we kind of do afull array of evaluation to see is there’ssomething mechanical, or is theresomething behavioral? And “theres going” from there. Dr. McDonald, can we talkabout coffee a hour? I’m objecting at yourUChicago Medicine mug.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 extend us down thatpath, if you are able to. I want, for me, I’m probablya coffee junkie since years ago when I became a residentand had my firstly kid– my partner and I first kid– when I was an intern. So coffee became mandatory. And since then, Ijust have not stopped. Overall, coffeeis pretty healthful. So there’s a lot of concerns.A lot of times beings comein to me and in my clinic and say things like, I stoppedcoffee, I stop spicy nutrients. And I’m like, waita minute, where did all this negativeconnotation come from when it comes to coffeeand spicy nutrients and nonsense like that? Because ultimately, a lotof these foods are health. So black chocolate by itselfhas been associated with declined riskof liver cancer, and maybe even decreasedrisk of congestive heart failure. Now, when you add a lot ofsugar and a lot of cream 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. Solely in thestate of California, at least at Starbucksand other chocolate places, they have to positioned 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 definitely studies in humans.So the majority of members of thestudies in humans, again, is demonstrating that coffeedecreases the risk of cancers. But issues of concern really comesfrom the fact that coffee, especially when it’s roasted–so like our darker rib coffee– may have higher quantities of acarcinogen– a cancer beginning agent– called [? acro ?] aromatase. But that’s alsofound in potatoes. It’s also found in bread. It’s also foundin a lot of nutrients 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 actually knows that, because to set that upto answer that question, you’d have to do an unethical study, where you’re just pay parties [? acro ?] aromatasefor many years and then witnessing what happens. So we don’t know. But eventually, I suck chocolate. I probably suck maybe alittle bit less dark roasted. 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 make, so there’s definitely alink between obesity and cancer as well as outcomes relatedto cancer therapies. 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 associate not only to thedevelopment of cancer, but also 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 extremely strenuous provisions. Interesting. So a few questions. Many of these favourite dietsor high-pitched protein diets. And issues of 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 uptake. Now in the past, especiallylike in the’ 90 s, everyone was concerned about eating toomuch protein and that starting kidney failure.So I recollect yearsago when I was playing football and athletics, and parties were trying 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 to say. So that has all been discredited. And a lot of people– evenpeople with kidney disease– actually need protein, up until a certain point where they need dialysis. Then you really simply needto talk to a dietitian and make sure you’renot overdoing it. But for the most part, the protein concerns and kidney disease, you really don’t have to be concerned too much. Because most people aren’t goingsuper crazy with the protein. Another one of ourviewers says, I have a PCOS and aslightly high A1C. Would an endoscopic weightmanagement procedure be beneficial tohelping me lower my A1C? Yeah, I think that’sa great question. Unfortunately, one of thecommon gives of PCOS is weight-relatedchallenges in addition to menstrual cycleirregularities or having erratic stages. And so the medicine of PCOS orusing an endoscopic administration, it actually 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 suggests that theseendoscopic procedures, when they’re capable to lose that1 0% to 20% of your load, can improve hemoglobin A1C, canimprove parties with fatty liver infection, aimed at enhancing parties withblood pressure or cholesterol problems.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 hump and get you out of that. We examine a lot of patients whoare in that pre-diabetes phase, and they say theirnumbers are borderline. If they’re trying tocorrect that issue, weight loss will help tryto get them back down out of that range. 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 adapted to the person. But that’s an alarmsign for people. Because these things can help.Can I answer questions? Yeah, absolutely. So too, PCOS canbe very complicated. And it’s somethingthat really requires a multi-disciplinaryteam to manage. So now at theUniversity of Chicago, “were having” parties 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. Perfectly. Because there aremedications that are great treatmentsfor PCOS more. Like a lot of patientsare on metformin, which also is an a bloodsugar self-control prescription. So that may be enough tohelp this person get out of that scope with amildly elevated A1C. So as Ed mentioned, we work very closely with the endocrinologistto make sure that they’re inthe right approach.We don’t exactly offerone thing and say that this is what we do. But you have to lookat the whole picture. And sometimes, proceduresaren’t the liberty option. Sometimes prescriptions are. But we do tailor itindividually, I would say. Another spectator question. I’ve heard that women’shormones make it more difficult to lose weight. Would you approach a woman’sweight loss medicine differently thanyou would a boy? No.I mean, for the most part, yes. So females can have a hardertime to lose weight. But at the end of the day, truly, life revision is the foundation. And those changes 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 parties may havewhether or not they’re a candidate for bariatricsurgery, drugs, or endoscopy. But eventually, theequation, if you will, is relatively similar. It just so happens to be alittle bit more difficult, especially in women whoare post-menopausal. Yeah. We participate a lot of womenpatients actually come in who are interestedin endoscopic rehabilitations. And in fact, ourmost frequent patient are really those patients thathave had their second child, and they just can’tshake the force 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 somebodies 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 canker than a male. 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. Another question from a spectator. Vegan diet, yes or no? Yeah. I imply, it depends onyour taste penchants and what you’re really into. So if you want to do fruitsand veggies and has become a vegan, you can do thatin a healthy nature. 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 undesirable diet. Or you could just eat pastaall day and be a vegan, but you’re not eatingfruits and veggies. So I remember I was givinga community lecture, and someone came up to meand said they’re a vegan.And I ask questions 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 unhealthy began. But vegan as a whole, a lot of studies show that people maylive a little bit longer, if you look at some of theSeventh Day Adventist studies. They are eligible to havea decreased peril of cancer. So for some people, thatis a unusually workable option. People who are interestedin becoming a vegan, you have to be aware of thepossibility of B12 deficiency. So that’s somethingthat certainly occurs in the vegan population. But outside of that, youreally merely “re going to 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. Originating 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 have all youressential amino acids. So the only ones Ican think of offhand, quinoa is a completeprotein that’s plant-based. And I repute amaranth is also. But everythingelse, you’re going to have a combinationof different seeds, different nuts, anddifferent beans.And utilizing thatcombination will get you all those essentialamino 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 seizures 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 diet. 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 words of how itaffects our bowel bacteria, those studies alsoneed to be done and are actively being done. And I think someof our investigates, precisely Jane Chang islooking at some of those, trying to answer someof those questions. But from a weight lossperspective solely, people can lose weightwith a ketogenic nutrition. But at the end of theday, the majority of members of these diets are certainly restrictingyour calories, and actually chipping back on someof these ultra-processed foods. Dr. Chapman, anyparting words for us? No. I think this was fantastic. I hope everyone learned a great deal. And you know, I hope you gota taste of how Ed and I wield very closely together, and thatwe are here to help people.And if you have anyquestions, we’re always happy to reach out. Clearly. Perfect. And we want to stressthe continuum of maintenance. Because there are a lot ofservices that are available here at UChicagoMedicine for kinfolks that want to lose weightand change your lifestyle in a safe mode. Yeah, absolutely. So I consider parties 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 miss moreinformation about UChicago Medicine’s weightmanagement program, 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 ..