June 23, 2022 • 48 mins
Bariatric surgery can also be called weight loss surgery. Some people think it's a highly underused tool to fight obesity. Others think it's a shortcut. We discuss all the ins and outs in this week's episode.
See omnystudio.com/listener for privacy information.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to Stuff You Should Know, a production of I
Heart Radio. Hey, and welcome to the podcast. I'm Josh,
and there's Chuck and Jerry's lurking around here like a
creeper weirdo who takes pictures of people without their permission.
And this is stuff you should know. I like that.
(00:24):
The joke is so nice. I said it twice. Uh
So we should issue a trigger warning before this episode
because we are talking about bariatric surgery, which some people
refer to as weight loss surgery, and the topic of
food and weight and weight loss and obesity and weight
loss surgery could be very triggering for people. So if
(00:45):
you want to listen to this one, great, we're gonna
just break it down like we usually do. But if
it's something that you don't want to listen to, we
totally understand. Yeah. I mean, after researching this, I totally
get why, like a fat positive or somebody who would
be triggered by talk of that could be upset by
it because there's a there's a pretty substantial argument to
(01:06):
be made that bariatric surgery is conducted just to make
obese and overweight people acceptable to society. That that's basically
the upshot of of why people get this surgery done.
That's not necessarily true for everybody, but there's a whole
there's a whole school of thought that says, you know,
this is this is a medical form of fat shaming
(01:30):
for some people at least. Yeah. And there's another school
of thought that it's uh, you know, uh, disease solving surgery. Uh.
And the evidence plays out that it really does help
with things like diabetes and hypertension and can be very successful.
The reason I thought of this to begin with was
(01:52):
I saw a Box article called We're barely using the
best tool we have to fight obesity, uh. And this
sort of cruxt of that article, which we'll talk about here,
is that only about one percent of people who qualify
for bariatric surgery use it. And the Vox article was
all behind it and basically said, we have this great tool,
(02:14):
uh for people that cannot seem to get down to
what is a healthy weight for them who are suffering
from hypertension diabetes, And they were saying, like, people should
use the surgery more. And there's a lot of reasons
why people don't, which we're also going to talk about. Yeah,
I mean, there's one thing that everybody can agree on,
like bariatric surgery works for weight loss to to it's
(02:36):
like a spectrum of how much it works, but it
definitely works. There's substantial results once it happens, and understandably so,
because it is a radical surgical procedure where you're like
really profoundly altering your internal anatomy so that you can,
in some cases except less food, in some cases digest
food less or have less of a chance to digest food.
(02:59):
And we should point out we're talking about modern bariatric
surgery because even ten years ago, results were wildly different.
The preferred surgeries were wildly different. And uh, they've come
a long long way in the past even ten years. Yeah,
it definitely has hit its stride in the last ten
years for sure. Um, but there's uh, as far as
(03:21):
the history of this whole idea goes, it's not a
new concept. Um. It goes back at least to the
end of the nineteenth century. Some people say it goes
back as far as the tenth century, which is amazing
to think about. And you know what, Olivia helped us
with this, and I had a feeling when I said, hey,
let's cover the history I was like, there's got to
(03:42):
be some you know, hundreds and hundreds of year old
procedure that somebody did. And if you believe the story,
in the tenth century, there was a King Sancho of
Leon and Sancho was so big. And this is when
Ed McMahon chimes in, how big was he? He was,
oh big that he couldn't ride a horse or walk
(04:03):
ouch as the story. As the story goes, so the
doctor did the most basic form of weight loss surgery
at the time, which was the suture King Sancho's lips
shut so that King Sancho could only ingest a liquid
diet and apparently lost about half his weight and got
(04:23):
the thrown back. So that's a nuts so story. I
find something else that comes later chuck even more nuts so. No. Um,
In the twenty one century, there was a push um
to basically reintroduce jaw wiring. Oh yeah, yeah, it's so
(04:45):
this whole thing with King Sancho, one of the original
kings of Leon. Um Like it got picked up like
a thousand or so years later. Um, even though it's
been shown nut to work, as we'll see, But the
whole like modern bariatric surgery um actually was born in
the nineteenth century out of um uh the same kinds
of procedures, but for a totally different purpose. UM. A
(05:08):
guy named Caesar rue came up with a surgical technique
called the ruin why and UM. It was used in
case you had like some sort of like um bowel
or gastric obstruction. He figured out how to bypass it
um and and connect your stomach to a different part
of your intestine to get around the obstruction and yet
(05:29):
you would still have functioning parts UM. And that was
where the idea of um of gastric bypass surgery came from,
or the name of it, yeah, which all the way
back in nine two, which is really hard to believe,
but it uh. They called it ruin why because I
believe it's sort of forms y shape when you're finished.
And that was about mortality rate initially in no surprise,
(05:56):
but they got that down to about eleven, which is
really great for the time period, I think. And then
you know, things kind of went along as people were
experimenting with those obstruction UH surgeries. There were doctors that
started to say, hey, wait a minute, we now have
a thing called a scale and humans we don't just
(06:17):
need to put grain on it. Humans can stand on
it so we know how much we weigh. And everyone went,
what hey, that's a great idea. I can't wait to
weigh myself every day, is what everyone said. I haven't
weighed myself in a long time. I kind of quit
me either, me too, But hard to believe, but yes,
humans started weighing themselves, and all of a sudden in
(06:38):
the nineteen twenties and thirties, doctors started in patients started
paying attention to their you know, to their little literal weight,
not just like how they looked and how they felt
right weight gain and um being overweight and I'm using
scare quotes here, um or obese again, scare scare quotes.
Um became medicalized at point, like it became a medical issue,
(07:01):
a problem to be treated. And it's just that whole idea,
and that whole concept has has taken off since then.
It's just so so fully ingrained in our our society
that it's really interesting to think, like it's only been
around for maybe a hundred or so years. But um,
they basically would give you anything that you wanted to
(07:22):
lose weight, like amphetamines, laxatives, UM, just anything. You just
go to the doctor and he give you whatever. UM.
But it wasn't until the nineteen forties that that whole
idea of medicalizing um being overweight, uh like, really kind
of spread into society at large, when the insurance companies
(07:43):
got involved. Yeah, and I should point out to you
you're using scare quotes when you say things like overweight
and obese because there is so much individual variation in
in body weight and how people carry it and how
healthy they are. And we understand this, I mean, we
sort of understand this now as far as people accepting it,
but there's still not a lot of acceptance around it.
(08:05):
That's why when you calculate something like a b M
I that is for you know, to judge a population
that does not take into an account take into account
of an individual or their muscle mass or you know,
their body shape. So they kind of throw these tags
on overweight and obese and b M I that are
(08:27):
useful in a certain sense, but also not useful in
a certain sense. Yeah. And the b M I scale
was invented in the nineteenth century by a guy named
Adolf quite Alet. He was a sociologist and he based
exclusively on white Western Europeans. So in a way, you
could say the b m I scale has created the
(08:47):
ideal body form is a average sized or whatever the
b m I says, the average size white European. The
problem is that's that's a problem in and of itself,
because you now have a compartment that you're trying to
shove everybody in regardless, and if you're not in that
compartment that you're supposed to be in, you have a problem, um,
a medical problem even maybe even a life threatening problem. Um.
(09:10):
But more than that, if you're not white and Western European,
that scales shouldn't really apply to you. But that hasn't
kept humanity or people from plugging all of humanity into
that same b m I scale. So there's a lot
of questions about the bm I scale itself, and especially
in recent years. Yeah, and I hope everyone understands when
(09:31):
we use those terms. All of this goes into that. UM.
As doctors were looking at uh, you know, still kind
of performing these surgeries, they noticed that, hey, you can
lose weight, you know the initial ruin why when you
had an obstruction, They were like, wait, this is good
for weight loss? Too, because quite simply, your stomach is
(09:52):
smaller and your body is not absorbing. You can't eat
as much and it's not absorbing as many nutrients and
in you, they believe. The very first real deal weight
loss surgery occurred again from a Swedish surgeon named Victor
ein Rickson, when Victor removed a hundred hundred three centimeters
(10:13):
of small intestine from a woman, a thirty two year
old woman who didn't lose that much weight, but supposedly
it improved her life quality. Yeah, and just the next
year UH an American named Dr Richard Varco created a
slightly altered, ruined why procedure called the j juno ilio bypass.
(10:34):
I practiced that so many times. My brain just says, Nope,
you're never gonna get it right. The first time, I
think that was probably close. It was close, but there
was like a hitch and a stumble in there too.
Ju Juna lial is what I would say, oh, showing
off a but then may not be right either, and
that comes from I'm sorry, that's that's what the first time.
(10:56):
They called it bariatric surgery, right, yes, And bariatric is
from the Greek for weight or heavy UM. So they said,
I guess this is surgery for heavy people. Maybe I'm
not sure, but that's where that's that's about. The fifties
is about when that that name became applied to it UM.
And then in the sixties UM they were starting to
(11:17):
do studies and experimentation with it. And there was a
study that found that UM a temporary procedure where you
would have like your stomach moved to a different part
of your small intestine. Temporarily you lose the weight and
then they go reverse the procedure. They found that patients
just basically gained the weight back after the procedure was reversed.
(11:38):
And at that point in the early sixties, these surgeries
started to become permanent in nature pretty much across the board. Yeah,
you know, that was my first surprise in this research.
I thought, even modern bariatric bypasses and stuff, I thought
that was all a temporary thing, and that like, you
don't live with an egg sized stomach for the rest
(11:59):
of your life, and that's not true. You live with
an excized stomach the rest of your life. Yeah. They
as we'll see, they remove a significant portion of your
stomach in either one of the surgeries that you get,
and that when they do that, that's that's irreversible, that
part of your stomach is gone. What's amazing to me
is that they've gotten good enough at it that it
(12:20):
has tremendous results, and the complications have kind of died
down over the years to where the risk of death
is now down to about point one percent. Uh. In
the twenties, it's gotten that low, but just around two thousand,
twenty years ago, it was still up at one percent,
which is really high for a surgical procedure in the
(12:42):
Western world in the twentieth century, but they've they've whittled
it down ten times lower than it was twenty years
before because they started using lap of scopic surgery. That's right.
Olivia points out that point one percent is less than
knee replacement surgery, just to kind of put that, you know,
to frame that. Yeah, and also I want to correct myself.
(13:03):
It wasn't in the twenty first century. It was in
the mid twentieth century that they tried to bring back
jaw wiring, but it just doesn't work, that's right. And
as a result of the success rate and the obviously
whittling that death rate down to point one. UM surgeries
now are crunching up towards a three hundred thousand per year.
(13:24):
I think two hundred and fifty six thousand was the
last year that we have a number four, and that
was in twenty nineteen, as opposed to about twenty thousand
a year in the nineties and about a hundred and
fifty thousand and change in the mid two thousand's because
they said, hey, everybody, we don't killed nearly as many
of you as we used to come and get it.
(13:46):
Should we take a break? Sure? All right, that was
a good setup. So let's take a break and we'll
be right back. Okay, Chuck, So we're back, and I
(14:17):
think it's high time that we actually talked about how
a bariatric surgery goes UM. And there's a couple of
different ways you can go UM. Some are more popular
than others. It seems like one that used to be
more popular than ruin why the bypass has become less
popular in favor of one called sleeve. Guests Guests direct
to me, See, I can never get it. The first
(14:39):
time you want to say gastronomy, I did. I wanted
to say gastro pub Uh yeah, this is easily the
most common um performed today. This is the one that's
very very popular right now. They remove about eight of
your stomach and basically the stomach, instead of being a
large pouch, becomes a narrow sleeve. That's why it's called sleeve.
(15:03):
Gets struck to me, and it's it's very very simple,
and that you have a much, much, much much smaller stomach,
so you can't eat as much. You will feel full
more quickly. But what also happens is and I'm not
sure if they had a hunch this would happen, or
if they knew this would happen, but it also tricks
the body into releasing a few of those hormones that
(15:25):
say that you're hungry. So it's not like, oh, I'm
still hungry all the time. Like you just have a
smaller stomach. You eat less and you're satisfied. Yeah, you
eat less and you have the desire to eat less
on top of that. So, I mean you can imagine
that this has tremendous results. And I think that they
did know that that hormone um effect was going to
(15:47):
happen because they specifically remove a part of the stomach
called the fundest and that's the portion that expands when
you eat a lot of food, So your stomach can't
expand when you eat food. You got to keep that
in mind. And then also the funnest is where grellan
is largely made, and that's that hunger hormone. So you're
producing less grillan and you just can't physically fit that
(16:09):
much food into your stomach anymore. Right, And like I said,
it's the most popular form today. I think in the
mid two thousand's it was about eight bariatric surgeries. Now
or in twenty nineteen it was it's even more than
that two. I just don't have the most recent number.
I was, um, I just got back from vacation in
(16:30):
Mexico and one of the two families that we kind
of hung out with him buddied up with. I was
chatting with the guy and I was like, so, what
do you do and he said, I'm a bariatric surgeon
and no kidding. And I was like, what, We're about
to do a podcast episode on that, and he said,
what's a podcast. I'm just said, well, what's a bariatric surgery? Now?
(16:51):
He didn't ask that because we had already talked a
little bit, but he uh, very nice guy from Texas
and he um talked a little bit. I didn't like
want to bother him too much about it, although he
really really enjoyed talking about it because he's not only
a bariatric surgeon, but he's very much a wellness doctor
and he believes that it's just part of a wellness
(17:12):
plan for your life. Um, not just like all right,
we'll do it and then have fun in the world. Um.
So he was a good guy to talk to you.
But he talked about sleeve gast direct Uh here there
I went again, sleeve gastro pub being the most popular
gastro pub. Yeah, it is the most popular gastro pub
of all time. So what how does that surgery go? Though? Um,
(17:33):
it's pretty quick for one Yeah, I think it's like
forty to seventy minutes, not that long. You stay in
the hospital for a couple of nights. They keep an
eye on you. And one of the reasons they're keeping
an eye on you is because for two weeks afterward,
you can have nothing but a liquid diet. Because if
you go look up sleeve gastrectomy videos, Um, there's a
(17:54):
lot of computer animations out there that show you what
they're doing, so you can imagine that if you remove
probably doably, I think maybe of your stomach um, it
needs to heal. And the way that you help at
heal over the first two weeks is by just drinking
like broth, water, um, maybe some gatorade if you're feeling spicy. Um.
(18:16):
But again, remember like you're not sitting there going bonkers
wanting food. Um. Most people who have a sleeve gets
tructomy report having to make themselves eat. They have to
keep a strict schedule because they don't want to eat
like they used to, like most people want to eat. Yeah,
And I mean we'll talk a little bit about maintenance later,
(18:38):
but I think in the end they recommend you eat like,
you know, four to six very small meals a day,
Like there's no way around it. You're you're going to
change you're eating habits in your lifestyle in a big,
big way if you have this surgery. And I read
a lot of first person accounts of like, you know,
can you ever go out to eat again and said
(19:00):
down with your family and enjoy a meal, because if
you're filling something the size of an egg, it's like
can you even order a meal? And you know, everyone
that I read was it's like, yeah, you know, you
you get used to it. You go to the restaurant,
you order an appetizer maybe, and you don't even eat
half of the appetizer and you take the rest home.
You do a lot more talking at dinner, and you
(19:22):
don't drink alcohol. You can't drink liquids while you eat
at all. Um, they're saying, you know, you drink liquids
no more than thirty minutes before you have a meal
because there's so little room. Uh. I did see some
people say they could drink a little alcohol, but it's
really recommended you basically quit drinking. Certainly, you don't want
to drink beer when you have a tiny egg stomach. God,
(19:45):
oh my god, that sounds terrible. It does, um, but
you there's no way around it. You are changing your lifestyle.
But across the board, when I read all these first
person accounts, everyone was like, you get used to it,
and the trade off is for them the they are
much healthier and happier and generally didn't have the regrets.
I'm sure you could find some people that had regrets
(20:07):
and were like, I missed sitting down and eating big
meals with my friends and family. But I mean, most
of the people that I read were pretty satisfied with
the surgery. So um, after you get surgery too, and
I can imagine they're satisfied because when you get a
sleeve guests trick to me UM, the doctors who performed
this these kind of procedures they use as something called
(20:28):
excess weight to qualify the success of the surgery. And
excess weight is the difference between your ideal weight and
what you weighed before the surgery and eighteen months after
the procedure, patients typically have lost about seventy percent of
their of their body weight after after the surgery. Within
(20:51):
a year and a half, their excess weight, right, Yes,
they're excess weight. Yeah, And you know, generally it's not
like uh, the days of your with gastric banding, which
has really gone out of favor, UM a lot of complications,
the weight generally did not stay off. But with sleeve
gastrectomy and then as we'll see with gastric bypass, the
(21:12):
weight does tend to stay off for years, although people
do gain some of the weight back. UM. One study
saw after twelve years about forty percent of patients had
maintained a thirty percent weight loss or more compared to
their original total weight, and where at least ten percent
lighter than they'd been. So sixty percent of people gain
(21:37):
back more than thirty percent of their weight. Is that
a way to say it? Yeah, I have to admit
you just made my brain do a somersault. But yes,
that's the that's the that's the converse, I guess. Huh. Yes,
So sixty percent of people gain back more than that
thirty percent, But it doesn't mean they gained all the
weight back that could have been. No, because again, like
(21:58):
you said, sent or at least ten percent lighter than
they've been before a lot of percentages flying around here. Yeah. So,
but the upshot is is that you are definitely going
to lose weight if you're a physician, UM, especially if
you're a bariatric surgeon. You consider bariatric surgery the gold
standard for rapid and sustained weight loss. That like, that's
(22:23):
if if you have a patient who is um like
again obese UM to a to like maybe say three
hundred four hundred pounds or more UM, you would say, look,
you really need the surgery and it's going to change
your life. It's you would probably also tell them it's
going to save their life too. Again, it's questionable, but
(22:44):
that's the medical stance, that's right. Uh. Then we have
the gastric bypass, the original rue on y or r
y GB surgery. Uh. They staple off part of your stomach.
They reduce that remaining part too. Again about this as
an egg, and then they attach it to that rue
lamb of the small intestine and you're you know, most
(23:06):
of that stomach and the upper small intestine is now bypass.
That's why they call it bypass surgery. And this one
is I think there are a few more complications now
and that's why this one's fallen out of favor a
little bit. Compared to sleeve guest struck to me, right, Yeah,
the impression I have is that sleeve gets struck to me,
is much more um or much less complicated afterward, because
(23:29):
you're not messing with the original plumbing. All you're doing
is removing a large section of the stomach. Everything else
remains as is, so you still have like a risk
of developing an infection or leakage in your stomach or
all sorts of stuff. UM, but you're not like bypassing,
you're not detaching the stomach and then reattaching it elsewhere,
(23:50):
which adds an entirely different dimension to that surgery. And
that's what ruined. Why is and when you're doing that, Chuck,
The reason why you're doing that, UM is because you're
you're basically, UM keeping the small intestine from being able
to digest as much like fats carbohydrates all that stuff
(24:11):
from the food you eat, so you're eating less, but
you're also digesting less of it or absorbing less of it,
so that leads to rapid weight loss as well. That's right. So,
like we said, as far as this being an effective thing, uh,
you know, losing weight for some people is really really
really hard. So for some people it is a mountain
(24:32):
that they cannot overcome. Uh, diets, you know, I think
the verdict is in across the board on diets, which
is diets are a quick fix and it's very hard
to keep that maintenance. Everybody basically agrees that UM, long
term weight loss involves life complete lifestyle change and not
some kind of crazy diet that you're doing, or even
(24:55):
not crazy diet that you're doing. UM. Exercise we've talked
about on the podcast is great for your body, but
you cannot exercise the weight off if you don't change
the food and drink portion of your life precisely. And
even even when you do diet like um, you you
may actually change your body so that you aren't able
(25:17):
to lose weight after a point, and when you stop dieting,
you may gain back more weight than before, So that
could be dangerous for sure. You don't want to mess
with your metabolism too much. Um and I would direct
people to our Intuitive Eating episode. We talked a lot
about that, but um that like that, Like you said,
the verdict being in on dieting has really kind of
(25:41):
supported the idea of bariatric surgery is not only the
gold standard but really the only real option you have
if you want to lose a serious amount of weight.
Um and so uh A lot of people have been
studying like just how how effective it is, and like
you said, um, you know, there's there's lots of percentages
(26:01):
flying around and how many people kept how much weight off,
But there was this one study that looked at people
who have gastric bypass surgery and contestants on the biggest
loser UM, which is a weight loss competition that's been
on TV forever UM and they use them because it's
hard to find a group of people who lose about
(26:22):
as much weight as you would lose with the gastric
bypass surgery UM, but without using gastric bypass surgery, So
they made like an ideal control group. That's right, uh,
And what they found is really super interesting. Both groups
lost about the same amount of weight, or at least
similar amounts. But the biggest loser group I hate even
(26:44):
saying that, I hate that dumb title. The biggest loser
group experience what's called metabolic adaptation, which is to say
that their metabolism slowed down and it made it harder
to keep that weight off. So six years on down
the road, that control group with the biggest loser uh
bunch had regained a lot of that weight, but their
(27:06):
metabolism was still really low uh and lower than and
slower than it was to begin with, So it kind
of permanently altered. It seems like I don't know about permanently,
but at least six years later had had altered their metabolism.
It's not permanent, no, but they will have to go
through the process of retraining their body to not store
(27:26):
as much fat or burn energy slower um in order
to get back to normal. But that's what dieting can
really do to you. But what happened with the other group, Well,
the other group, the bariatric surgery patients. They they're metabolism stabilized.
So there's a lot of rapid weight loss just because
you're you're taking in less, but also because your body
(27:48):
is not producing hunger hormones like growing and it may
actually actually produce more of the satiated um. Is that right?
Satiated satiety, sure, sitcom um sat safety hormone leapton so um,
they're metabolism. Actually, it just stabilized. So eventually they stopped
(28:10):
losing weight, maybe gained a little bit back, but typically
kind of hold um. What's what's referred to as a
baseline weight, basically the weight that your body and your
metabolism says, this is how much you should weigh. Try
as you will, we're always going to try to get
back to this, and if you mess with us, we're
gonna make it harder on you than ever, right, Which
I mean, that's study really makes a pretty good case
(28:33):
for bariatric surgery as an option for people. Right, Uh,
so does this There was a meta analysis in that
saw certain we talked earlier about, you know, health complications
from caring too much weight UM, that bariatric surgery reduces
the risk to develop type two diabetes by h and
(28:55):
hypertension by six and if you already had those conditions
going in, which can be one of the criteria to
get the surgery to begin with. Uh, the surgery was
associated with remission. Even so, just to take a little sidebar,
I didn't understand how people can say, okay, if you
if you have if you're faced with data like that,
(29:15):
how can you possibly say that obesity um is not
necessarily linked with poor health, or that there's a concept
called healthy at any size, which I want to do
an episode on eventually. UM. And the thing that I
saw the explanation is, yes, these things are associated with obesity,
with being overweight. But it's the point is is if
(29:38):
you're a b obese or overweight, you're not automatically going
to get type two diabetes, not automatically going to develop hypertension.
And in much the same way that smokers may or
may not develop lung cancer. People who are overweight or
obese may or may not develop type two diabetes or
hypertension or some of the other um maladies I guess
(30:00):
associated with being overweight by the medical establishment. Yeah, yeah,
it's a good way to look at it. Yeah, I
just wanted to add that. Sure, but Chuck, the thing
is it is it is evident that yes, if you
do have those maladies, Yeah, gastric bypass surgery bariatric surgery
will definitely help your health outcomes as a result. Yeah,
(30:22):
or headed toward those, And it's not like if you
get regular physicals, you know when you're headed toward those,
towards type two diabetes and hypertension. It's not like a
switch is just flicked and you're like, all right, I've
got those two conditions now, Like you know the blood
tests that they give you, and trust me, I've been
I go every year now, Like I want to know
(30:42):
about my body. I'm not one of these guys who
is overweight and like just buries my head in the sand,
probably to my detriment. Want to get too many tests
done and things like that, because I want to know
what's up. But you know, I've seen my own health
like creep up towards those numbers two levels that I
don't like, So then I have to work to like
(31:03):
get those numbers back down. And it's all it's all
data driven, and it's all from blood tests. And I
just encourage people to go get their physicals every year.
There's no I know people that bury their head in
the sand and are just like, I just don't want
to know about that stuff. And I just think people
should really be uh advocate for their own health and
(31:26):
and uh, what's the word I'm looking for when you
are just sort of preemptively um, sort of getting tests
to find out where you stand, you know, um taking action, Yeah,
well taking action on the medical side. Uh, so you
can take action you know at home. Yeah. It also
you know, you don't have to go to a doctor
(31:47):
to get blood tests. You can you can order your
own basically and just go to like quest or lab
Corps or something. Oh yeah, just like do your own
blood pail. Yeah yeah, and they have you know, the
results show if you're in like a normal range or
whatever over for everything. Yeah, or if you cut yourself,
squeeze a little bit on a piece of white paper
and just look at it for a while that's right,
what does it look like? It's like reading tea leaves
(32:09):
or chicken guts? Uh, what was I gonna say? Oh?
There they did. As far as the meta analysis another
study with that analysis, they found about half the people
with type two diabetes that had the surgery had enough
improvement that they could get off their medication. And that's
what remission basically is. It's sort of like you're always
(32:29):
an alcoholic even though you quit drinking, Like technically you're
still diabetic, but if it's in remission, that means you've
gotten your numbers down to a safe level, you can
get off the medication and stuff like that. So um. Also,
by the way, there's that's questionable as well as whether
you're still an alcoholic after you quit drinking. Well is it? Yeah?
I mean it's sort of just terminology though right, No,
(32:52):
not necessarily. I think there's a there's definitely a school
thought that's that's once an addict, always an addict, Like
you will always be addicted. Even if you for the
rest of your life fifties sixty seventy years without ever
taking another drink, you'll always be an alcoholic. Other people say, no,
that's that's not true, And that's a whole mindset that
keeps people trapped in this idea that they're addicted or
(33:13):
an alcoholic when they aren't any longer, and it produces
a lot of unnecessary shame and hardship. You know. I'm
glad to hear that because I always thought that was
weird when someone who like quit drinking twenty years ago says,
I'm still an alcoholic, And I just thought that's not
for me to judge, Like that's their terminology that they
need to use. But I always thought that was a
(33:34):
strange way to think about it. So, but I think
that does apply for some people. I'm not saying for
all people. Yeah, it's just the opposite is true as well. Um,
just because you're an alcoholic, it doesn't mean you're always
going to be an alcoholic for everybody. Okay, I got you, so,
chuck chuck chuck. Yes, I say we take a break.
(33:56):
All right, let's do it. I'm gonna go into remission
and use the restroom. All right, we're back. I'm glad
(34:28):
we cleared that up about alcoholism. Yeah, I didn't know
that that was going to pop up. I didn't either,
And I'm glad you said something though, that's that's good information. Yeah,
I might say it stuff you should know. I just
used the line that I hate that everyone else uses
when you first meet them and tell them what you do.
Oh yeah, at some point when you meet someone new
and you tell what you do in the name of
(34:48):
the show, at some point they say, oh, that sounds
like stuff you should know. Right, Yeah, they definitely do,
or they'll hit you with So tell me something I
should know. Yeah. I also realized just this week why
some people who right in abbreviate the show s U
s K. I've never understood what they were doing. I
(35:08):
finally noticed the why and the you are next to
each other on the keyboard on a querity keyboard. Oh
you think that's what it is. It's got it's got
to be. I just figured people were doing the Prince
thing or just you know, internet shorthand for you as
you right, But it doesn't make Oh yeah, I guess
it does. It does. Okay, Well, maybe back in the
(35:30):
wilderness as much as I was before. Um, let's talk
about some risk factors. You did talk about leakage always is,
you know, just with any kind of abdominal surgery, you
might get there's a risk of infection and clotting, hernia, ulcer, gallstones,
(35:51):
botwel obstructions. I think most I think you find more
of those specific ones in the gastric bypass rather than
the sleep eve and then explain to everyone with these
two great words together mean dumping syndrome one of the
most unfortunately named medical conditions that has ever been put.
I think so dumping syndrome is where you basically um,
(36:15):
when you're eating after gastric bypass surgery or bariatric surgery. UM,
the food just moves out of your stomach too quick.
It's not it's not predigested enough, so when it hits
your um guts, it causes cramps, it can cause diarrhea.
There's another variation called late dumping syndrome, where if you
eat a an overly sugary meal or snack or whatever, um,
(36:41):
it can drop your blood sugar precipitously because so much
insulin gets released because again it wasn't predigested or pre
absorbed in any way. It just kind of shows up
in your gut like here, I am, I'm a bite
of steak. Let's see what we can do. Yeah, the
other thing you're gonna have to do is potentially takes supplements. Uh,
(37:02):
you know, just because you're eating so little, you're also
getting a fewer um good things into your body. And
you know, hopefully you're eating good things if you continue
to eat just very small amounts of bad stuff. And
again we're using scare quotes, but you know, if if
I get this and I continue just to eat fried
chicken and mashed potatoes, then I'm not giving my body
(37:24):
the nutrients that it needs, and you might need to
take supplements. One thing you definitely have to do is
eat really really slow and chew like you've never chewed before. Yeah,
you gotta chew like um, Dr Kellogg. Yeah, I mean
I think you're essentially trying to trick your body into
thinking you're on sort of a liquid diet. Still. Yeah,
(37:47):
but I think also your body is sending you signals
like please please stop. The three bites of steak is
too much, you know, like it's sending you those signals.
So you're you, Yeah, And I think it's from what
I understand, take some um some working out on figuring
out how to eat under this new under these new circumstances.
(38:08):
It's a little bit of trial and error, but that
people you know, work it out over time. I bet
you really appreciate food. Yeah, I could see that being, uh,
an effect of it. I could also see becoming totally
neutral towards food being in effect of it as well. Yeah.
I mean they're definitely psychological impacts. And that is played
(38:31):
out with another interesting side effect, which is and I
saw this in a few places, is that you are
more likely to get divorced then if you didn't have
the surgery. And I think there was one study. There's
been plenty of studies, but there was one that found
nine got divorced after the surgery compared to six percent
(38:52):
of the control group. And there are a lot of
ways to look at that one. Certainly is it it? Uh?
Maybe you have the increased confidence to leave a relationship
you didn't have the confidence lead before that you should
have leaved, like a bad relationship. Apparently you get married
or in a relationship more if after you get the surgery,
(39:13):
which also could make a lot of sense. Yeah, which
is nice. I like that one. That's the silver lining
to the other cloud. You know. Um so if you
if you said, okay, what about me, how do I
know if I qualify for bariatric surgery, because I don't
know if we said or not, chuck. Um insurance will
cover it, Medicaid, Medicare, and private insurance will cover under
(39:34):
certain circumstances. Because again, obesity has been medicalized and is
this is seen as a disease or um a syndrome
or symptom of disease right or associated with disease, if
not a disease itself. So they've said, okay, we'll cover
this if you have a b m I of at
least forty or you're more than a hundred pounds overweight.
(39:57):
I was surprised it was just a hundred pounds. I
it have thought it would be more than that. Yeah, um,
Or if you have a b m I of thirty
five and you also have type two diabetes or sleep
apnea or hypertension or fatty liver disease, it's not from alcohol,
uh osteo arthritis, lipid abnormalities, heart disease, or gastro intestinal
(40:19):
disorders gastro pub disorders along with that thirty b m I.
Or if you have tried to lose weight with several
multiple efforts and are unable to UM and I think
that's included with the b M I right, yes, yeah,
and that's actually I mean, they'll they insurance companies will
(40:39):
make you jump through a lot of hoops, and one
of them is, um, you need to try to lose
weight and show that you can't before they'll ensure you.
In some cases, there's a lot of meanness to it.
Really if you step back and think, like, um, that
like that you're treating somebody like that, not because of
any medical condition, but because they're overweight. Um. But that's
(41:00):
that's what insurance companies do to get to pay for it.
And if you pay for it yourself. Roxane Gaye got
it done and wrote an essay about it, and she
said that she paid out of pocket because she didn't
want to have to jump through any hoops or red tape,
and she said that the cost was breathtaking, as she
put it, really so yes, I would get the impression
that the average person would not be able to afford
(41:20):
it out of pockets. So there are hoops you're gonna
have to jump through. Apparently, according to paper by Boston
Medical Center, UM, fewer than one percent of patients, like
we said, get the surgery that qualify and one of
the big reasons is a lot of physicians PCPs still
do not recommend it. Apparently you were five times more
(41:40):
likely to get it if it is recommended by your
primary care physician, but it just doesn't happen as much. Yeah,
And I think, um, a lot of the PCPs aren't
up on the advances that have been made in things
like mortality rates and the fact that it's moved over
to laparoscopic. So if you get like kind of old
and said in their ways a married care physician, they
(42:01):
might not know that bariatric surgery is much safer than
it used to be and you know, much less invasive.
Um like here, just have a sody pop and it'll
be fine. Exactly, have a diet coke. Um. So if
you if you do get bariatric surgery, there's a chance,
an eight percent chance that you are a woman. Right,
That's right. Even though um obcit rates are the same
(42:25):
for men and women, women are way more likely to
get the surgery. Also, when women get the surgery compared
to men, they are younger than their male counterparts. And
I think that it's more like referrals. You're more likely
to get the surgery because you've been referred by someone
who got it rather than coming from your doctor. Uh.
(42:48):
And it also shows that women in this is sad
and and not surprising at all that of women listed
psychosocial concerns as one of their biggest motivations, even over
related concerns. Yes, but um uh. Infertility has also been
strongly linked as far as I understand, to um being
(43:10):
overweight or obese. So it's possible that some of the
increase in women who get it, or the disproportion of
women who get it, could be because they're seeking to
have a family or have an easier pregnancy too. Right.
And again on the sort of general shaming outlook of
this surgery, there was a survey about five years ago
(43:32):
in a poll I guess that in the US, um
almost people responded that bariatric surgery was the easy way
out rather than just like losing weight the old fashioned way. Yeah,
because that's and that's just so that's such a crock
because it's like, hey, you should really lose a bunch
of weight. Oh you're getting bariatric surgery. That's the easy
(43:53):
way out. And that really underscores how much people look
at being overweight as an individual moral failing that there
is ah, there's something wrong with you, yeah, or a
choice um or um that you just you're just lazy
or you just can't help yourself, whatever, so much so
that that just people who are overweight or obese or
(44:16):
just look down upon. They don't they're not treated with
the same kind of dignity that an average sized person
would be. And this actually shows up in medical settings too.
Apparently doctors um will not pay as much attention to
health indicators like UM cholesterol level or UM glucost levels
or whatever um, and instead just pay attention to the
(44:38):
appearance of an overweight or obese patient when they recommend
gastric bypass or bariatric surgery. So they're it's they're not
saying it's because you're hypertense or because you have diabetes.
They're essentially saying it's strictly because you're overweight. Yeah, and
sort of. The one thing that's obvious to me is
(45:00):
everything that I've seen about the surgery, the recovery, your
lifestyle afterward for the rest of your life. There's nothing
easy about it. It is not the easy way out.
It's not like, well, it's a forty minute surgery, then
you're good to go. It's it's not an easy thing
and it is a not something to go into lightly.
It is a major surgery that will completely alter the
(45:21):
way you eat, and a lot of people the way
they eat is a big part of their lifestyle in
their life and it will alter that forever. And it's
a big, huge, monumental change and there's nothing easy about it.
But it is your decision. It's up to you. UM.
From what I've seen about the fat positive activist community, UM,
(45:44):
they would probably recommend that you reflect on exactly why
you want the surgery. Is it because you are being
pressured by family, friends, society, um? Or is it just
for whatever reason? And whatever reason you have, it's your again,
it's your decision. No one can tell you that it's
right or wrong, but you should definitely educate yourself on
(46:05):
you know, the risks and the benefits and everything about it,
and then just make your decision and feel good about
it either way. Yeah. I agree. I hope this. Uh.
I think this is like one of those topics that
you know, people might research, you know, late at night
even and feeling shamed to even look into this kind
of procedure and hopefully we could clear up some of
(46:26):
this stuff and if if something people feel good about,
then they can own it and move forward with their
head held high. Very nice. You got anything else? I
got nothing else. Well, since Chuck said he's got nothing else,
that of course means it's time for a listener mail.
I'm gonna call this just a new listener from Canada.
(46:47):
I don't think that's how they see it. I'm a
new listener. Just want to say how much I enjoy
the show. My husband told me about stuff you should know,
and I kind of brushed them off, thinking this was
just another boring podcast trying to teach me boring thing.
But I finally gave it a shot and was hooked.
After the very first show I listened to you guys
have great chemistry, and I heard another listener call you
(47:07):
burten Ernie type of burten Ernie type. I feel that
I'll take that you have a great mix of random
knowledge and important knowledge, and I'll love your true crime
episodes to hope you keep going forever. And you should
know my husband is not letting me live this down
that he is the greatest podcast taste that is. From
Autumn in the Thunder Bay, Ontario, Canada, North America. Planet
(47:32):
Earth very nice thought them. Thank you very much, and
we're glad that you're with us, even though it was
your husband who made you do it. That's right. If
you want to be like Autumn and get in touch
with us, we would love that you can send us
an email. That's the best way to do it. Just
wrap it up, spank it on the bottom lightly, and
send it off to Stuff Podcasts at iHeart radio dot com.
(47:57):
Stuff you Should Know is a production of I heart Radio.
For more podcasts my heart Radio, visit the i heart
Radio app, Apple Podcasts, or wherever you listen to your
favorite shows. H m hm
Welcome to Stuff You Should Know, a production of I
Heart Radio. Hey, and welcome to the podcast. I'm Josh,
and there's Chuck and Jerry's lurking around here like a
creeper weirdo who takes pictures of people without their permission.
And this is stuff you should know. I like that.
(00:24):
The joke is so nice. I said it twice. Uh
So we should issue a trigger warning before this episode
because we are talking about bariatric surgery, which some people
refer to as weight loss surgery, and the topic of
food and weight and weight loss and obesity and weight
loss surgery could be very triggering for people. So if
(00:45):
you want to listen to this one, great, we're gonna
just break it down like we usually do. But if
it's something that you don't want to listen to, we
totally understand. Yeah. I mean, after researching this, I totally
get why, like a fat positive or somebody who would
be triggered by talk of that could be upset by
it because there's a there's a pretty substantial argument to
(01:06):
be made that bariatric surgery is conducted just to make
obese and overweight people acceptable to society. That that's basically
the upshot of of why people get this surgery done.
That's not necessarily true for everybody, but there's a whole
there's a whole school of thought that says, you know,
this is this is a medical form of fat shaming
(01:30):
for some people at least. Yeah. And there's another school
of thought that it's uh, you know, uh, disease solving surgery. Uh.
And the evidence plays out that it really does help
with things like diabetes and hypertension and can be very successful.
The reason I thought of this to begin with was
(01:52):
I saw a Box article called We're barely using the
best tool we have to fight obesity, uh. And this
sort of cruxt of that article, which we'll talk about here,
is that only about one percent of people who qualify
for bariatric surgery use it. And the Vox article was
all behind it and basically said, we have this great tool,
(02:14):
uh for people that cannot seem to get down to
what is a healthy weight for them who are suffering
from hypertension diabetes, And they were saying, like, people should
use the surgery more. And there's a lot of reasons
why people don't, which we're also going to talk about. Yeah,
I mean, there's one thing that everybody can agree on,
like bariatric surgery works for weight loss to to it's
(02:36):
like a spectrum of how much it works, but it
definitely works. There's substantial results once it happens, and understandably so,
because it is a radical surgical procedure where you're like
really profoundly altering your internal anatomy so that you can,
in some cases except less food, in some cases digest
food less or have less of a chance to digest food.
(02:59):
And we should point out we're talking about modern bariatric
surgery because even ten years ago, results were wildly different.
The preferred surgeries were wildly different. And uh, they've come
a long long way in the past even ten years. Yeah,
it definitely has hit its stride in the last ten
years for sure. Um, but there's uh, as far as
(03:21):
the history of this whole idea goes, it's not a
new concept. Um. It goes back at least to the
end of the nineteenth century. Some people say it goes
back as far as the tenth century, which is amazing
to think about. And you know what, Olivia helped us
with this, and I had a feeling when I said, hey,
let's cover the history I was like, there's got to
(03:42):
be some you know, hundreds and hundreds of year old
procedure that somebody did. And if you believe the story,
in the tenth century, there was a King Sancho of
Leon and Sancho was so big. And this is when
Ed McMahon chimes in, how big was he? He was,
oh big that he couldn't ride a horse or walk
(04:03):
ouch as the story. As the story goes, so the
doctor did the most basic form of weight loss surgery
at the time, which was the suture King Sancho's lips
shut so that King Sancho could only ingest a liquid
diet and apparently lost about half his weight and got
(04:23):
the thrown back. So that's a nuts so story. I
find something else that comes later chuck even more nuts so. No. Um,
In the twenty one century, there was a push um
to basically reintroduce jaw wiring. Oh yeah, yeah, it's so
(04:45):
this whole thing with King Sancho, one of the original
kings of Leon. Um Like it got picked up like
a thousand or so years later. Um, even though it's
been shown nut to work, as we'll see, But the
whole like modern bariatric surgery um actually was born in
the nineteenth century out of um uh the same kinds
of procedures, but for a totally different purpose. UM. A
(05:08):
guy named Caesar rue came up with a surgical technique
called the ruin why and UM. It was used in
case you had like some sort of like um bowel
or gastric obstruction. He figured out how to bypass it
um and and connect your stomach to a different part
of your intestine to get around the obstruction and yet
(05:29):
you would still have functioning parts UM. And that was
where the idea of um of gastric bypass surgery came from,
or the name of it, yeah, which all the way
back in nine two, which is really hard to believe,
but it uh. They called it ruin why because I
believe it's sort of forms y shape when you're finished.
And that was about mortality rate initially in no surprise,
(05:56):
but they got that down to about eleven, which is
really great for the time period, I think. And then
you know, things kind of went along as people were
experimenting with those obstruction UH surgeries. There were doctors that
started to say, hey, wait a minute, we now have
a thing called a scale and humans we don't just
(06:17):
need to put grain on it. Humans can stand on
it so we know how much we weigh. And everyone went,
what hey, that's a great idea. I can't wait to
weigh myself every day, is what everyone said. I haven't
weighed myself in a long time. I kind of quit
me either, me too, But hard to believe, but yes,
humans started weighing themselves, and all of a sudden in
(06:38):
the nineteen twenties and thirties, doctors started in patients started
paying attention to their you know, to their little literal weight,
not just like how they looked and how they felt
right weight gain and um being overweight and I'm using
scare quotes here, um or obese again, scare scare quotes.
Um became medicalized at point, like it became a medical issue,
(07:01):
a problem to be treated. And it's just that whole idea,
and that whole concept has has taken off since then.
It's just so so fully ingrained in our our society
that it's really interesting to think, like it's only been
around for maybe a hundred or so years. But um,
they basically would give you anything that you wanted to
(07:22):
lose weight, like amphetamines, laxatives, UM, just anything. You just
go to the doctor and he give you whatever. UM.
But it wasn't until the nineteen forties that that whole
idea of medicalizing um being overweight, uh like, really kind
of spread into society at large, when the insurance companies
(07:43):
got involved. Yeah, and I should point out to you
you're using scare quotes when you say things like overweight
and obese because there is so much individual variation in
in body weight and how people carry it and how
healthy they are. And we understand this, I mean, we
sort of understand this now as far as people accepting it,
but there's still not a lot of acceptance around it.
(08:05):
That's why when you calculate something like a b M
I that is for you know, to judge a population
that does not take into an account take into account
of an individual or their muscle mass or you know,
their body shape. So they kind of throw these tags
on overweight and obese and b M I that are
(08:27):
useful in a certain sense, but also not useful in
a certain sense. Yeah. And the b M I scale
was invented in the nineteenth century by a guy named
Adolf quite Alet. He was a sociologist and he based
exclusively on white Western Europeans. So in a way, you
could say the b m I scale has created the
(08:47):
ideal body form is a average sized or whatever the
b m I says, the average size white European. The
problem is that's that's a problem in and of itself,
because you now have a compartment that you're trying to
shove everybody in regardless, and if you're not in that
compartment that you're supposed to be in, you have a problem, um,
a medical problem even maybe even a life threatening problem. Um.
(09:10):
But more than that, if you're not white and Western European,
that scales shouldn't really apply to you. But that hasn't
kept humanity or people from plugging all of humanity into
that same b m I scale. So there's a lot
of questions about the bm I scale itself, and especially
in recent years. Yeah, and I hope everyone understands when
(09:31):
we use those terms. All of this goes into that. UM.
As doctors were looking at uh, you know, still kind
of performing these surgeries, they noticed that, hey, you can
lose weight, you know the initial ruin why when you
had an obstruction, They were like, wait, this is good
for weight loss? Too, because quite simply, your stomach is
(09:52):
smaller and your body is not absorbing. You can't eat
as much and it's not absorbing as many nutrients and
in you, they believe. The very first real deal weight
loss surgery occurred again from a Swedish surgeon named Victor
ein Rickson, when Victor removed a hundred hundred three centimeters
(10:13):
of small intestine from a woman, a thirty two year
old woman who didn't lose that much weight, but supposedly
it improved her life quality. Yeah, and just the next
year UH an American named Dr Richard Varco created a
slightly altered, ruined why procedure called the j juno ilio bypass.
(10:34):
I practiced that so many times. My brain just says, Nope,
you're never gonna get it right. The first time, I
think that was probably close. It was close, but there
was like a hitch and a stumble in there too.
Ju Juna lial is what I would say, oh, showing
off a but then may not be right either, and
that comes from I'm sorry, that's that's what the first time.
(10:56):
They called it bariatric surgery, right, yes, And bariatric is
from the Greek for weight or heavy UM. So they said,
I guess this is surgery for heavy people. Maybe I'm
not sure, but that's where that's that's about. The fifties
is about when that that name became applied to it UM.
And then in the sixties UM they were starting to
(11:17):
do studies and experimentation with it. And there was a
study that found that UM a temporary procedure where you
would have like your stomach moved to a different part
of your small intestine. Temporarily you lose the weight and
then they go reverse the procedure. They found that patients
just basically gained the weight back after the procedure was reversed.
(11:38):
And at that point in the early sixties, these surgeries
started to become permanent in nature pretty much across the board. Yeah,
you know, that was my first surprise in this research.
I thought, even modern bariatric bypasses and stuff, I thought
that was all a temporary thing, and that like, you
don't live with an egg sized stomach for the rest
(11:59):
of your life, and that's not true. You live with
an excized stomach the rest of your life. Yeah. They
as we'll see, they remove a significant portion of your
stomach in either one of the surgeries that you get,
and that when they do that, that's that's irreversible, that
part of your stomach is gone. What's amazing to me
is that they've gotten good enough at it that it
(12:20):
has tremendous results, and the complications have kind of died
down over the years to where the risk of death
is now down to about point one percent. Uh. In
the twenties, it's gotten that low, but just around two thousand,
twenty years ago, it was still up at one percent,
which is really high for a surgical procedure in the
(12:42):
Western world in the twentieth century, but they've they've whittled
it down ten times lower than it was twenty years
before because they started using lap of scopic surgery. That's right.
Olivia points out that point one percent is less than
knee replacement surgery, just to kind of put that, you know,
to frame that. Yeah, and also I want to correct myself.
(13:03):
It wasn't in the twenty first century. It was in
the mid twentieth century that they tried to bring back
jaw wiring, but it just doesn't work, that's right. And
as a result of the success rate and the obviously
whittling that death rate down to point one. UM surgeries
now are crunching up towards a three hundred thousand per year.
(13:24):
I think two hundred and fifty six thousand was the
last year that we have a number four, and that
was in twenty nineteen, as opposed to about twenty thousand
a year in the nineties and about a hundred and
fifty thousand and change in the mid two thousand's because
they said, hey, everybody, we don't killed nearly as many
of you as we used to come and get it.
(13:46):
Should we take a break? Sure? All right, that was
a good setup. So let's take a break and we'll
be right back. Okay, Chuck, So we're back, and I
(14:17):
think it's high time that we actually talked about how
a bariatric surgery goes UM. And there's a couple of
different ways you can go UM. Some are more popular
than others. It seems like one that used to be
more popular than ruin why the bypass has become less
popular in favor of one called sleeve. Guests Guests direct
to me, See, I can never get it. The first
(14:39):
time you want to say gastronomy, I did. I wanted
to say gastro pub Uh yeah, this is easily the
most common um performed today. This is the one that's
very very popular right now. They remove about eight of
your stomach and basically the stomach, instead of being a
large pouch, becomes a narrow sleeve. That's why it's called sleeve.
(15:03):
Gets struck to me, and it's it's very very simple,
and that you have a much, much, much much smaller stomach,
so you can't eat as much. You will feel full
more quickly. But what also happens is and I'm not
sure if they had a hunch this would happen, or
if they knew this would happen, but it also tricks
the body into releasing a few of those hormones that
(15:25):
say that you're hungry. So it's not like, oh, I'm
still hungry all the time. Like you just have a
smaller stomach. You eat less and you're satisfied. Yeah, you
eat less and you have the desire to eat less
on top of that. So, I mean you can imagine
that this has tremendous results. And I think that they
did know that that hormone um effect was going to
(15:47):
happen because they specifically remove a part of the stomach
called the fundest and that's the portion that expands when
you eat a lot of food, So your stomach can't
expand when you eat food. You got to keep that
in mind. And then also the funnest is where grellan
is largely made, and that's that hunger hormone. So you're
producing less grillan and you just can't physically fit that
(16:09):
much food into your stomach anymore. Right, And like I said,
it's the most popular form today. I think in the
mid two thousand's it was about eight bariatric surgeries. Now
or in twenty nineteen it was it's even more than
that two. I just don't have the most recent number.
I was, um, I just got back from vacation in
(16:30):
Mexico and one of the two families that we kind
of hung out with him buddied up with. I was
chatting with the guy and I was like, so, what
do you do and he said, I'm a bariatric surgeon
and no kidding. And I was like, what, We're about
to do a podcast episode on that, and he said,
what's a podcast. I'm just said, well, what's a bariatric surgery? Now?
(16:51):
He didn't ask that because we had already talked a
little bit, but he uh, very nice guy from Texas
and he um talked a little bit. I didn't like
want to bother him too much about it, although he
really really enjoyed talking about it because he's not only
a bariatric surgeon, but he's very much a wellness doctor
and he believes that it's just part of a wellness
(17:12):
plan for your life. Um, not just like all right,
we'll do it and then have fun in the world. Um.
So he was a good guy to talk to you.
But he talked about sleeve gast direct Uh here there
I went again, sleeve gastro pub being the most popular
gastro pub. Yeah, it is the most popular gastro pub
of all time. So what how does that surgery go? Though? Um,
(17:33):
it's pretty quick for one Yeah, I think it's like
forty to seventy minutes, not that long. You stay in
the hospital for a couple of nights. They keep an
eye on you. And one of the reasons they're keeping
an eye on you is because for two weeks afterward,
you can have nothing but a liquid diet. Because if
you go look up sleeve gastrectomy videos, Um, there's a
(17:54):
lot of computer animations out there that show you what
they're doing, so you can imagine that if you remove
probably doably, I think maybe of your stomach um, it
needs to heal. And the way that you help at
heal over the first two weeks is by just drinking
like broth, water, um, maybe some gatorade if you're feeling spicy. Um.
(18:16):
But again, remember like you're not sitting there going bonkers
wanting food. Um. Most people who have a sleeve gets
tructomy report having to make themselves eat. They have to
keep a strict schedule because they don't want to eat
like they used to, like most people want to eat. Yeah,
And I mean we'll talk a little bit about maintenance later,
(18:38):
but I think in the end they recommend you eat like,
you know, four to six very small meals a day,
Like there's no way around it. You're you're going to
change you're eating habits in your lifestyle in a big,
big way if you have this surgery. And I read
a lot of first person accounts of like, you know,
can you ever go out to eat again and said
(19:00):
down with your family and enjoy a meal, because if
you're filling something the size of an egg, it's like
can you even order a meal? And you know, everyone
that I read was it's like, yeah, you know, you
you get used to it. You go to the restaurant,
you order an appetizer maybe, and you don't even eat
half of the appetizer and you take the rest home.
You do a lot more talking at dinner, and you
(19:22):
don't drink alcohol. You can't drink liquids while you eat
at all. Um, they're saying, you know, you drink liquids
no more than thirty minutes before you have a meal
because there's so little room. Uh. I did see some
people say they could drink a little alcohol, but it's
really recommended you basically quit drinking. Certainly, you don't want
to drink beer when you have a tiny egg stomach. God,
(19:45):
oh my god, that sounds terrible. It does, um, but
you there's no way around it. You are changing your lifestyle.
But across the board, when I read all these first
person accounts, everyone was like, you get used to it,
and the trade off is for them the they are
much healthier and happier and generally didn't have the regrets.
I'm sure you could find some people that had regrets
(20:07):
and were like, I missed sitting down and eating big
meals with my friends and family. But I mean, most
of the people that I read were pretty satisfied with
the surgery. So um, after you get surgery too, and
I can imagine they're satisfied because when you get a
sleeve guests trick to me UM, the doctors who performed
this these kind of procedures they use as something called
(20:28):
excess weight to qualify the success of the surgery. And
excess weight is the difference between your ideal weight and
what you weighed before the surgery and eighteen months after
the procedure, patients typically have lost about seventy percent of
their of their body weight after after the surgery. Within
(20:51):
a year and a half, their excess weight, right, Yes,
they're excess weight. Yeah, And you know, generally it's not
like uh, the days of your with gastric banding, which
has really gone out of favor, UM a lot of complications,
the weight generally did not stay off. But with sleeve
gastrectomy and then as we'll see with gastric bypass, the
(21:12):
weight does tend to stay off for years, although people
do gain some of the weight back. UM. One study
saw after twelve years about forty percent of patients had
maintained a thirty percent weight loss or more compared to
their original total weight, and where at least ten percent
lighter than they'd been. So sixty percent of people gain
(21:37):
back more than thirty percent of their weight. Is that
a way to say it? Yeah, I have to admit
you just made my brain do a somersault. But yes,
that's the that's the that's the converse, I guess. Huh. Yes,
So sixty percent of people gain back more than that
thirty percent, But it doesn't mean they gained all the
weight back that could have been. No, because again, like
(21:58):
you said, sent or at least ten percent lighter than
they've been before a lot of percentages flying around here. Yeah. So,
but the upshot is is that you are definitely going
to lose weight if you're a physician, UM, especially if
you're a bariatric surgeon. You consider bariatric surgery the gold
standard for rapid and sustained weight loss. That like, that's
(22:23):
if if you have a patient who is um like
again obese UM to a to like maybe say three
hundred four hundred pounds or more UM, you would say, look,
you really need the surgery and it's going to change
your life. It's you would probably also tell them it's
going to save their life too. Again, it's questionable, but
(22:44):
that's the medical stance, that's right. Uh. Then we have
the gastric bypass, the original rue on y or r
y GB surgery. Uh. They staple off part of your stomach.
They reduce that remaining part too. Again about this as
an egg, and then they attach it to that rue
lamb of the small intestine and you're you know, most
(23:06):
of that stomach and the upper small intestine is now bypass.
That's why they call it bypass surgery. And this one
is I think there are a few more complications now
and that's why this one's fallen out of favor a
little bit. Compared to sleeve guest struck to me, right, Yeah,
the impression I have is that sleeve gets struck to me,
is much more um or much less complicated afterward, because
(23:29):
you're not messing with the original plumbing. All you're doing
is removing a large section of the stomach. Everything else
remains as is, so you still have like a risk
of developing an infection or leakage in your stomach or
all sorts of stuff. UM, but you're not like bypassing,
you're not detaching the stomach and then reattaching it elsewhere,
(23:50):
which adds an entirely different dimension to that surgery. And
that's what ruined. Why is and when you're doing that, Chuck,
The reason why you're doing that, UM is because you're
you're basically, UM keeping the small intestine from being able
to digest as much like fats carbohydrates all that stuff
(24:11):
from the food you eat, so you're eating less, but
you're also digesting less of it or absorbing less of it,
so that leads to rapid weight loss as well. That's right. So,
like we said, as far as this being an effective thing, uh,
you know, losing weight for some people is really really
really hard. So for some people it is a mountain
(24:32):
that they cannot overcome. Uh, diets, you know, I think
the verdict is in across the board on diets, which
is diets are a quick fix and it's very hard
to keep that maintenance. Everybody basically agrees that UM, long
term weight loss involves life complete lifestyle change and not
some kind of crazy diet that you're doing, or even
(24:55):
not crazy diet that you're doing. UM. Exercise we've talked
about on the podcast is great for your body, but
you cannot exercise the weight off if you don't change
the food and drink portion of your life precisely. And
even even when you do diet like um, you you
may actually change your body so that you aren't able
(25:17):
to lose weight after a point, and when you stop dieting,
you may gain back more weight than before, So that
could be dangerous for sure. You don't want to mess
with your metabolism too much. Um and I would direct
people to our Intuitive Eating episode. We talked a lot
about that, but um that like that, Like you said,
the verdict being in on dieting has really kind of
(25:41):
supported the idea of bariatric surgery is not only the
gold standard but really the only real option you have
if you want to lose a serious amount of weight.
Um and so uh A lot of people have been
studying like just how how effective it is, and like
you said, um, you know, there's there's lots of percentages
(26:01):
flying around and how many people kept how much weight off,
But there was this one study that looked at people
who have gastric bypass surgery and contestants on the biggest
loser UM, which is a weight loss competition that's been
on TV forever UM and they use them because it's
hard to find a group of people who lose about
(26:22):
as much weight as you would lose with the gastric
bypass surgery UM, but without using gastric bypass surgery, So
they made like an ideal control group. That's right, uh,
And what they found is really super interesting. Both groups
lost about the same amount of weight, or at least
similar amounts. But the biggest loser group I hate even
(26:44):
saying that, I hate that dumb title. The biggest loser
group experience what's called metabolic adaptation, which is to say
that their metabolism slowed down and it made it harder
to keep that weight off. So six years on down
the road, that control group with the biggest loser uh
bunch had regained a lot of that weight, but their
(27:06):
metabolism was still really low uh and lower than and
slower than it was to begin with, So it kind
of permanently altered. It seems like I don't know about permanently,
but at least six years later had had altered their metabolism.
It's not permanent, no, but they will have to go
through the process of retraining their body to not store
(27:26):
as much fat or burn energy slower um in order
to get back to normal. But that's what dieting can
really do to you. But what happened with the other group, Well,
the other group, the bariatric surgery patients. They they're metabolism stabilized.
So there's a lot of rapid weight loss just because
you're you're taking in less, but also because your body
(27:48):
is not producing hunger hormones like growing and it may
actually actually produce more of the satiated um. Is that right?
Satiated satiety, sure, sitcom um sat safety hormone leapton so um,
they're metabolism. Actually, it just stabilized. So eventually they stopped
(28:10):
losing weight, maybe gained a little bit back, but typically
kind of hold um. What's what's referred to as a
baseline weight, basically the weight that your body and your
metabolism says, this is how much you should weigh. Try
as you will, we're always going to try to get
back to this, and if you mess with us, we're
gonna make it harder on you than ever, right, Which
I mean, that's study really makes a pretty good case
(28:33):
for bariatric surgery as an option for people. Right, Uh,
so does this There was a meta analysis in that
saw certain we talked earlier about, you know, health complications
from caring too much weight UM, that bariatric surgery reduces
the risk to develop type two diabetes by h and
(28:55):
hypertension by six and if you already had those conditions
going in, which can be one of the criteria to
get the surgery to begin with. Uh, the surgery was
associated with remission. Even so, just to take a little sidebar,
I didn't understand how people can say, okay, if you
if you have if you're faced with data like that,
(29:15):
how can you possibly say that obesity um is not
necessarily linked with poor health, or that there's a concept
called healthy at any size, which I want to do
an episode on eventually. UM. And the thing that I
saw the explanation is, yes, these things are associated with obesity,
with being overweight. But it's the point is is if
(29:38):
you're a b obese or overweight, you're not automatically going
to get type two diabetes, not automatically going to develop hypertension.
And in much the same way that smokers may or
may not develop lung cancer. People who are overweight or
obese may or may not develop type two diabetes or
hypertension or some of the other um maladies I guess
(30:00):
associated with being overweight by the medical establishment. Yeah, yeah,
it's a good way to look at it. Yeah, I
just wanted to add that. Sure, but Chuck, the thing
is it is it is evident that yes, if you
do have those maladies, Yeah, gastric bypass surgery bariatric surgery
will definitely help your health outcomes as a result. Yeah,
(30:22):
or headed toward those, And it's not like if you
get regular physicals, you know when you're headed toward those,
towards type two diabetes and hypertension. It's not like a
switch is just flicked and you're like, all right, I've
got those two conditions now, Like you know the blood
tests that they give you, and trust me, I've been
I go every year now, Like I want to know
(30:42):
about my body. I'm not one of these guys who
is overweight and like just buries my head in the sand,
probably to my detriment. Want to get too many tests
done and things like that, because I want to know
what's up. But you know, I've seen my own health
like creep up towards those numbers two levels that I
don't like, So then I have to work to like
(31:03):
get those numbers back down. And it's all it's all
data driven, and it's all from blood tests. And I
just encourage people to go get their physicals every year.
There's no I know people that bury their head in
the sand and are just like, I just don't want
to know about that stuff. And I just think people
should really be uh advocate for their own health and
(31:26):
and uh, what's the word I'm looking for when you
are just sort of preemptively um, sort of getting tests
to find out where you stand, you know, um taking action, Yeah,
well taking action on the medical side. Uh, so you
can take action you know at home. Yeah. It also
you know, you don't have to go to a doctor
(31:47):
to get blood tests. You can you can order your
own basically and just go to like quest or lab
Corps or something. Oh yeah, just like do your own
blood pail. Yeah yeah, and they have you know, the
results show if you're in like a normal range or
whatever over for everything. Yeah, or if you cut yourself,
squeeze a little bit on a piece of white paper
and just look at it for a while that's right,
what does it look like? It's like reading tea leaves
(32:09):
or chicken guts? Uh, what was I gonna say? Oh?
There they did. As far as the meta analysis another
study with that analysis, they found about half the people
with type two diabetes that had the surgery had enough
improvement that they could get off their medication. And that's
what remission basically is. It's sort of like you're always
(32:29):
an alcoholic even though you quit drinking, Like technically you're
still diabetic, but if it's in remission, that means you've
gotten your numbers down to a safe level, you can
get off the medication and stuff like that. So um. Also,
by the way, there's that's questionable as well as whether
you're still an alcoholic after you quit drinking. Well is it? Yeah?
I mean it's sort of just terminology though right, No,
(32:52):
not necessarily. I think there's a there's definitely a school
thought that's that's once an addict, always an addict, Like
you will always be addicted. Even if you for the
rest of your life fifties sixty seventy years without ever
taking another drink, you'll always be an alcoholic. Other people say, no,
that's that's not true, And that's a whole mindset that
keeps people trapped in this idea that they're addicted or
(33:13):
an alcoholic when they aren't any longer, and it produces
a lot of unnecessary shame and hardship. You know. I'm
glad to hear that because I always thought that was
weird when someone who like quit drinking twenty years ago says,
I'm still an alcoholic, And I just thought that's not
for me to judge, Like that's their terminology that they
need to use. But I always thought that was a
(33:34):
strange way to think about it. So, but I think
that does apply for some people. I'm not saying for
all people. Yeah, it's just the opposite is true as well. Um,
just because you're an alcoholic, it doesn't mean you're always
going to be an alcoholic for everybody. Okay, I got you, so,
chuck chuck chuck. Yes, I say we take a break.
(33:56):
All right, let's do it. I'm gonna go into remission
and use the restroom. All right, we're back. I'm glad
(34:28):
we cleared that up about alcoholism. Yeah, I didn't know
that that was going to pop up. I didn't either,
And I'm glad you said something though, that's that's good information. Yeah,
I might say it stuff you should know. I just
used the line that I hate that everyone else uses
when you first meet them and tell them what you do.
Oh yeah, at some point when you meet someone new
and you tell what you do in the name of
(34:48):
the show, at some point they say, oh, that sounds
like stuff you should know. Right, Yeah, they definitely do,
or they'll hit you with So tell me something I
should know. Yeah. I also realized just this week why
some people who right in abbreviate the show s U
s K. I've never understood what they were doing. I
(35:08):
finally noticed the why and the you are next to
each other on the keyboard on a querity keyboard. Oh
you think that's what it is. It's got it's got
to be. I just figured people were doing the Prince
thing or just you know, internet shorthand for you as
you right, But it doesn't make Oh yeah, I guess
it does. It does. Okay, Well, maybe back in the
(35:30):
wilderness as much as I was before. Um, let's talk
about some risk factors. You did talk about leakage always is,
you know, just with any kind of abdominal surgery, you
might get there's a risk of infection and clotting, hernia, ulcer, gallstones,
(35:51):
botwel obstructions. I think most I think you find more
of those specific ones in the gastric bypass rather than
the sleep eve and then explain to everyone with these
two great words together mean dumping syndrome one of the
most unfortunately named medical conditions that has ever been put.
I think so dumping syndrome is where you basically um,
(36:15):
when you're eating after gastric bypass surgery or bariatric surgery. UM,
the food just moves out of your stomach too quick.
It's not it's not predigested enough, so when it hits
your um guts, it causes cramps, it can cause diarrhea.
There's another variation called late dumping syndrome, where if you
eat a an overly sugary meal or snack or whatever, um,
(36:41):
it can drop your blood sugar precipitously because so much
insulin gets released because again it wasn't predigested or pre
absorbed in any way. It just kind of shows up
in your gut like here, I am, I'm a bite
of steak. Let's see what we can do. Yeah, the
other thing you're gonna have to do is potentially takes supplements. Uh,
(37:02):
you know, just because you're eating so little, you're also
getting a fewer um good things into your body. And
you know, hopefully you're eating good things if you continue
to eat just very small amounts of bad stuff. And
again we're using scare quotes, but you know, if if
I get this and I continue just to eat fried
chicken and mashed potatoes, then I'm not giving my body
(37:24):
the nutrients that it needs, and you might need to
take supplements. One thing you definitely have to do is
eat really really slow and chew like you've never chewed before. Yeah,
you gotta chew like um, Dr Kellogg. Yeah, I mean
I think you're essentially trying to trick your body into
thinking you're on sort of a liquid diet. Still. Yeah,
(37:47):
but I think also your body is sending you signals
like please please stop. The three bites of steak is
too much, you know, like it's sending you those signals.
So you're you, Yeah, And I think it's from what
I understand, take some um some working out on figuring
out how to eat under this new under these new circumstances.
(38:08):
It's a little bit of trial and error, but that
people you know, work it out over time. I bet
you really appreciate food. Yeah, I could see that being, uh,
an effect of it. I could also see becoming totally
neutral towards food being in effect of it as well. Yeah.
I mean they're definitely psychological impacts. And that is played
(38:31):
out with another interesting side effect, which is and I
saw this in a few places, is that you are
more likely to get divorced then if you didn't have
the surgery. And I think there was one study. There's
been plenty of studies, but there was one that found
nine got divorced after the surgery compared to six percent
(38:52):
of the control group. And there are a lot of
ways to look at that one. Certainly is it it? Uh?
Maybe you have the increased confidence to leave a relationship
you didn't have the confidence lead before that you should
have leaved, like a bad relationship. Apparently you get married
or in a relationship more if after you get the surgery,
(39:13):
which also could make a lot of sense. Yeah, which
is nice. I like that one. That's the silver lining
to the other cloud. You know. Um so if you
if you said, okay, what about me, how do I
know if I qualify for bariatric surgery, because I don't
know if we said or not, chuck. Um insurance will
cover it, Medicaid, Medicare, and private insurance will cover under
(39:34):
certain circumstances. Because again, obesity has been medicalized and is
this is seen as a disease or um a syndrome
or symptom of disease right or associated with disease, if
not a disease itself. So they've said, okay, we'll cover
this if you have a b m I of at
least forty or you're more than a hundred pounds overweight.
(39:57):
I was surprised it was just a hundred pounds. I
it have thought it would be more than that. Yeah, um,
Or if you have a b m I of thirty
five and you also have type two diabetes or sleep
apnea or hypertension or fatty liver disease, it's not from alcohol,
uh osteo arthritis, lipid abnormalities, heart disease, or gastro intestinal
(40:19):
disorders gastro pub disorders along with that thirty b m I.
Or if you have tried to lose weight with several
multiple efforts and are unable to UM and I think
that's included with the b M I right, yes, yeah,
and that's actually I mean, they'll they insurance companies will
(40:39):
make you jump through a lot of hoops, and one
of them is, um, you need to try to lose
weight and show that you can't before they'll ensure you.
In some cases, there's a lot of meanness to it.
Really if you step back and think, like, um, that
like that you're treating somebody like that, not because of
any medical condition, but because they're overweight. Um. But that's
(41:00):
that's what insurance companies do to get to pay for it.
And if you pay for it yourself. Roxane Gaye got
it done and wrote an essay about it, and she
said that she paid out of pocket because she didn't
want to have to jump through any hoops or red tape,
and she said that the cost was breathtaking, as she
put it, really so yes, I would get the impression
that the average person would not be able to afford
(41:20):
it out of pockets. So there are hoops you're gonna
have to jump through. Apparently, according to paper by Boston
Medical Center, UM, fewer than one percent of patients, like
we said, get the surgery that qualify and one of
the big reasons is a lot of physicians PCPs still
do not recommend it. Apparently you were five times more
(41:40):
likely to get it if it is recommended by your
primary care physician, but it just doesn't happen as much. Yeah,
And I think, um, a lot of the PCPs aren't
up on the advances that have been made in things
like mortality rates and the fact that it's moved over
to laparoscopic. So if you get like kind of old
and said in their ways a married care physician, they
(42:01):
might not know that bariatric surgery is much safer than
it used to be and you know, much less invasive.
Um like here, just have a sody pop and it'll
be fine. Exactly, have a diet coke. Um. So if
you if you do get bariatric surgery, there's a chance,
an eight percent chance that you are a woman. Right,
That's right. Even though um obcit rates are the same
(42:25):
for men and women, women are way more likely to
get the surgery. Also, when women get the surgery compared
to men, they are younger than their male counterparts. And
I think that it's more like referrals. You're more likely
to get the surgery because you've been referred by someone
who got it rather than coming from your doctor. Uh.
(42:48):
And it also shows that women in this is sad
and and not surprising at all that of women listed
psychosocial concerns as one of their biggest motivations, even over
related concerns. Yes, but um uh. Infertility has also been
strongly linked as far as I understand, to um being
(43:10):
overweight or obese. So it's possible that some of the
increase in women who get it, or the disproportion of
women who get it, could be because they're seeking to
have a family or have an easier pregnancy too. Right.
And again on the sort of general shaming outlook of
this surgery, there was a survey about five years ago
(43:32):
in a poll I guess that in the US, um
almost people responded that bariatric surgery was the easy way
out rather than just like losing weight the old fashioned way. Yeah,
because that's and that's just so that's such a crock
because it's like, hey, you should really lose a bunch
of weight. Oh you're getting bariatric surgery. That's the easy
(43:53):
way out. And that really underscores how much people look
at being overweight as an individual moral failing that there
is ah, there's something wrong with you, yeah, or a
choice um or um that you just you're just lazy
or you just can't help yourself, whatever, so much so
that that just people who are overweight or obese or
(44:16):
just look down upon. They don't they're not treated with
the same kind of dignity that an average sized person
would be. And this actually shows up in medical settings too.
Apparently doctors um will not pay as much attention to
health indicators like UM cholesterol level or UM glucost levels
or whatever um, and instead just pay attention to the
(44:38):
appearance of an overweight or obese patient when they recommend
gastric bypass or bariatric surgery. So they're it's they're not
saying it's because you're hypertense or because you have diabetes.
They're essentially saying it's strictly because you're overweight. Yeah, and
sort of. The one thing that's obvious to me is
(45:00):
everything that I've seen about the surgery, the recovery, your
lifestyle afterward for the rest of your life. There's nothing
easy about it. It is not the easy way out.
It's not like, well, it's a forty minute surgery, then
you're good to go. It's it's not an easy thing
and it is a not something to go into lightly.
It is a major surgery that will completely alter the
(45:21):
way you eat, and a lot of people the way
they eat is a big part of their lifestyle in
their life and it will alter that forever. And it's
a big, huge, monumental change and there's nothing easy about it.
But it is your decision. It's up to you. UM.
From what I've seen about the fat positive activist community, UM,
(45:44):
they would probably recommend that you reflect on exactly why
you want the surgery. Is it because you are being
pressured by family, friends, society, um? Or is it just
for whatever reason? And whatever reason you have, it's your again,
it's your decision. No one can tell you that it's
right or wrong, but you should definitely educate yourself on
(46:05):
you know, the risks and the benefits and everything about it,
and then just make your decision and feel good about
it either way. Yeah. I agree. I hope this. Uh.
I think this is like one of those topics that
you know, people might research, you know, late at night
even and feeling shamed to even look into this kind
of procedure and hopefully we could clear up some of
(46:26):
this stuff and if if something people feel good about,
then they can own it and move forward with their
head held high. Very nice. You got anything else? I
got nothing else. Well, since Chuck said he's got nothing else,
that of course means it's time for a listener mail.
I'm gonna call this just a new listener from Canada.
(46:47):
I don't think that's how they see it. I'm a
new listener. Just want to say how much I enjoy
the show. My husband told me about stuff you should know,
and I kind of brushed them off, thinking this was
just another boring podcast trying to teach me boring thing.
But I finally gave it a shot and was hooked.
After the very first show I listened to you guys
have great chemistry, and I heard another listener call you
(47:07):
burten Ernie type of burten Ernie type. I feel that
I'll take that you have a great mix of random
knowledge and important knowledge, and I'll love your true crime
episodes to hope you keep going forever. And you should
know my husband is not letting me live this down
that he is the greatest podcast taste that is. From
Autumn in the Thunder Bay, Ontario, Canada, North America. Planet
(47:32):
Earth very nice thought them. Thank you very much, and
we're glad that you're with us, even though it was
your husband who made you do it. That's right. If
you want to be like Autumn and get in touch
with us, we would love that you can send us
an email. That's the best way to do it. Just
wrap it up, spank it on the bottom lightly, and
send it off to Stuff Podcasts at iHeart radio dot com.
(47:57):
Stuff you Should Know is a production of I heart Radio.
For more podcasts my heart Radio, visit the i heart
Radio app, Apple Podcasts, or wherever you listen to your
favorite shows. H m hm
Stuff You Should Know News
Hosts And Creators
Chuck Bryant
Josh Clark
Show Links
AboutOrder Our BookStoreSYSK ArmyRSSPopular Podcasts
Las Culturistas with Matt Rogers and Bowen Yang
Ding dong! Join your culture consultants, Matt Rogers and Bowen Yang, on an unforgettable journey into the beating heart of CULTURE. Alongside sizzling special guests, they GET INTO the hottest pop-culture moments of the day and the formative cultural experiences that turned them into Culturistas. Produced by the Big Money Players Network and iHeartRadio.
40s and Free Agents: NFL Draft Season
Daniel Jeremiah of Move the Sticks and Gregg Rosenthal of NFL Daily join forces to break down every team's needs this offseason.
Crime Junkie
Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by audiochuck Media Company.