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Dr. Jean CADY and his team were interviewed by Dr. Sihem TLEMSANI, founder and Chief Executive Officer of CM GLOBAL SOLUTIONS. The Director wished to garner the testimonies of medical experts in order to inform people about the viable solutions that exist to cure the two serious pathologies of diabetes and/or obesity.
- Former director of the medical clinic (A.I.H.P).
- Assistant in Paris hospitals.
- Member of the European society of cancer surgery.
- Digestive and stomach surgery.
- Laparoscopic surgery, obesity and diabetes.
- A member of the academy of surgical operations.
- A former expert at the appeals court in Paris.
- A founder of the multidisciplinary center for obesity surgery and diabetes treatment (CMCO) with his team of specialists.
- Medical consultant for cm-global solutions.
Doctor. Jean CADY, you have completed a large number of operations on people around the world, especially in France. Among the thousands of patients, you have treated are cinema stars, show business celebrities, a Nobel prize winner, politicians, athletes, members of the royal families of the Gulf and the Arab world, and even a whole royal family.
For a great number of these patients whom you operated on, you carried out surgical procedures to treat obesity and diabetes.
I had the chance to meet some of those patients, Dr. CADY, and they recounted how they felt reborn the day after their operation. You are the main reason for their new-found happiness.
It was in France, in 2005, when Dr. CADY introduced the technology of the mini circumvention (mini-bypass), an invention that has improved the practice of laparoscopy and minimized its side effects. Dr. CADY has now completed the approval process for this ingenious technology.
Dr. CADY, the French specialist of bariatric surgery, has developed this innovative treatment for diabetes and obesity through the ingenious method of mini-circumvention.
You have participated in many international societies, but your main object was to teach people about obesity surgery, and to listen carefully and help the patients of this disease — and also of diabetes, which is its corollary.
Q. Dr. S.T. to Dr. CADY: How do you define obesity?
Obesity is a widespread and prevalent disease around the globe. For people who live with obesity, it’s simply a fact of life. It’s often viewed as “collateral damage” of the consumer society. It’s a disease that has thousands of disadvantages because it’s a real disease that is not recognized as such. Although it is a chronic disease, its severity increases over time. Everyone knows that obesity is incurable. Moreover, it’s a life-threatening disease, as it reduces your life expectancy as you gain more weight.
As this disease is not recognized by society, many of those with obesity are discriminated — and women especially. These patients usually suffer from diabetes. Fifteen percent of obesity patients become diabetes patients. The form of diabetes we are discussing is the one that starts off as diabetes type 2; but after a while it deteriorates into the more serious form, diabetes type 1, which is very difficult to cure. Moreover, this will cause many complications as a result of how diabetes affects the micro vessels, which we call microangiopathy. You can feel the effects of that just by raising your toes, whereupon you can suddenly face an unbearable polyneuritis. It’s a condition that can lead to a tragic end. But, with surgery, all of these side effects of diabetes can be eliminated, and, in this sense, can be cured.
Q. Dr. S.T. to Dr. CADY: What is diabetes and what are its complications?
Diabetes is a disease that we can call alimentary. Although diabetes can’t be cured, we can reduce its effects by following a strict diet. This is the first treatment for diabetes. We start by recommending a diet, but then, unfortunately, the patient tends to revert to bad habits. They forget to adhere to their diet, and then the diabetes will worsen. And so the patient gains weight. The diabetes returns. At this stage the diabetes is partial, so we can treat it with medication such as metformin, which is taken orally.
Then, things progress, and the older we are, the worse the diabetes becomes. When the situation becomes worse, we need to use insulin. And this becomes a terrible challenge, especially when we reach the stage of insulin pumps. An insulin pump is a small piece of equipment worn around the stomach, which is uncomfortable.
So this is what diabetes is today. It affects a large percentage of the population in France; but it is also widespread around the globe and especially prevalent in the Arab world, where diabetes is a serious disease. So I think it must be timely to make a dramatic change in those countries — to examine other radical solutions that go beyond treatment by medication.
Q. Dr. S.T. to Dr. CADY: In your experience, why does the Arab world have the highest incidence of diabetes? What is the main reason?
I have many friends living in the Arab world, and I think it’s because of their diet. It would appear that the amount of food they eat in the Gulf countries is very dangerous to the small intestinal cells. I believe that this causes diabetes and is also the reason for the prevalence of being overweight. The fatter you are, the more likely you are to develop diabetes. So, this is my answer: it’s obvious that the greater your body mass index (BMI), the more likely you are to have diabetes.
Q. Dr. S.T. My third question involves an American bariatric surgeon, Dr. PORIES, who in 1992, postulated that this kind of bypass might enable us to cure diabetes?
First, this discovery is extremely interesting, but, before anything else, I would like to say that no bariatric operation will make you lose weight or cure diabetes. Unfortunately, in most of the bariatric operations we complete, patients gain back the fat and the diabetes will return. But this is not the case with bypass procedures. Whatever the type of bypass, it involves a derivation of the digestive juices. All types of the bypass can have curative effects for diabetes.
When Dr PORIES described curing diabetes with a gastric bypass, he was referring to the old classical, Roux-en-Y bypass. But it was out of the question to suggest a difficult surgical operation at that time because a Roux-en-Y bypass involves laparotomy, and that was obviously a very difficult operation that can’t even be compared to treatment with medication or even insulin. And here is what makes it fantastic: when Dr. Robert RUTLEDGE discovered a mini bypass that is extremely effective for the first time, is less dangerous, and cures diabetes in a very significant way, the upshot was that, overall, 90% of patients enjoy 13 years free of diabetes; that’s an overall remission rate of 90%, for an average of 13 years. I can vouch for this from my own experience, and that’s what makes it really important.
So, why not beyond 13 years? Why not 20 years?
I introduced this operation in 2005 in France. I noticed its benefits rapidly. And then I asked a very difficult question. I wanted to know: how is it done? It is done in a very complex way. In fact, as happens in all bariatric operations, we must create a small and narrow bag that will work as a reducer. That’s what we call an alimentary restriction. This alimentary restriction will obviously have the knock-on effect of improving the patient’s diabetic state, as it will cause a biliopancreatic derivation or a malabsorption. This means that the amount of the ingested food will be less than the amount of digested food. This is exactly what we discovered recently. This produced phenomena, hormonal and digestive modifications that we don’t fully understand. The role of the digestive hormones is so complex that, at present, it is too hard to fathom completely. And of course, there is also the insulin in our bodies, which is produced by the pancreas. This appeared at the end of a certain timespan. So, in effect, the bypass can reduce the insulin resistance in the bodies of diabetic people, and there is also another phenomenon that follows: glyconeogenesis, which is the manufacture of sugar by the intestine and, especially, the microbiota, which is another important consideration.
Q. Dr. S.T. to Dr. CADY: What makes the mini by-pass more important than others?
It’s simply because the derivation in it is longer than in the other by-pass procedures, which makes its effects more remarkable than the others’. Moreover, you have to pay attention when counting the height of these intestinal loops from one patient to another because not doing this accurately may cause malnutrition. So, a patient who receives a mini by-pass has the possibility of being cured of their diabetes, but this cannot be guaranteed beforehand.
If we want to maintain quality, the patients require follow-up and monitoring over time. It’s less crucial than the requirements of the diabetic who needs his diabetes specialist every five minutes. But the follow-up and monitoring require a team of doctors. I have created a multidisciplinary team at CMCO. And what I am especially excited about now is teaching. I have taught many surgeons in Paris at our hospital, but I have also taught abroad where I have given courses in Maghreb countries and even in Asian countries.
Q. Dr. S.T. to Dr. CADY: Can we now say that the mini by-pass is an excellent treatment for diabetes caused by obesity?
Treating diabetes through surgery should be based on a principle: the balance between the benefits and the risks. It is clear that we have to assure the patient who wants to be cured that the operation that will not damage him, cause a multitude of disastrous symptoms or kill him. These are the risks, but they are reduced. They are just the usual ones associated with a mini by-pass. Then, the benefits depend on the quality of the operation. Although the mini by-pass doesn’t lead to a cure, we discovered that it can lead to a remission. And a remission of 13 years, 13 years without diabetes, can justifiably be called a recovery.
Q. Dr. S.T. to Dr. CADY: The remission of diabetes is earlier than its associated weight loss. Why? How would you explain that?
It’s amazing. I will explain. As I mentioned earlier, it involves the complex phenomena that affect digestive hormones. The phenomena produce secretions from things that we don’t understand. This is very remarkable. We’re looking into this gradually over time since we started the operations. Many of the surgical operations have introduced new medical products and treatments.
This is surely the case for diabetes as well, but we don’t yet know about all of the complex phenomena associated with it. I don’t have the competence to explain because it relates to an area for the researchers to explore. Nowadays, if you have type 2 diabetes, it can still be treated orally with medication; but, after a few years you will have to take insulin , or take the path of surgery. And if you have diabetes because of obesity, then undergoing the bypass operation will quickly result in a reduction of weight – in a way that you would find quite amazing.
Of course, many patients consult with us about obesity, not about their diabetes. They have diabetes, but they care only about losing weight. We make them lose weight in six months and they have very interesting results. Losing weight is an important stage, but it’s progressive. By contrast, the recovery from diabetes [with a gastric bypass] is almost immediate. Once you leave the hospital, I advise you to stop taking metformin, so we can monitor the progress more clearly. We can oversee the diabetes by taking a blood sample for glycemia. But we can monitor even more successfully via measuring the levels of a substance called hemoglobin glycosuria. We’ve found out that the fall of the hemoglobin glycosuria is almost immediate, and this is a very important phenomenon.
What is important about the bypass is that the obesity disappears, but unfortunately, for certain people, it returns because it’s a complex disease. It can be affected by many other aspects, such as alimentary and other physiological factors. When the obesity returns, it doesn’t necessarily mean that the diabetes returns as well. And that’s what proves that the mechanism is not only an alimentary change but is also a trial of extraordinary work. It is very important for the patient to benefit from this useful technique for the long term and, eventually, to be cured. And it may also enhance your microangiopathy. I can’t prove that because I’m not a researcher, but this is also a fundamental point that should be considered. Even if you have diabetes and you have lost your sight, the change in this respect will be also dramatic!
In two words, doctor, if you allow the patient to leave the hospital, he has, of course, a good dietary regime in place. Then, say, after three weeks, what if he starts a new diet that is totally different from the one he has been used to? If everything still seems okay, does it mean that diabetes has disappeared?
I always advise patients to continue their glycemia, but to stop medicines, in particular. Because with diabetes type 2 (I’m not talking about all types, such as the insulin-dependent type, which resists much more) the remission is almost immediate, and so if you take the medication on top, it will just lead to hypoglycemia.
Q. Dr. S.T. to Dr. CADY: What about the long term?
In my experience, the remission lasts for 13 years. That’s the timespan when you still feel good. And when I talk about a 90% success rate, this is among all my cases of diabetes. You have to understand the fringe diabetic of type 1, not the diabetes related to the weight and the children who suffer from pancreatic insufficiency. Researchers of type 1 diabetes complicate type 2, from obesity, which can be cured much less often, but it still can be cured. As such, it can be cured much less if we develop it in series. Actually, patients of the two types will not get 100% cured. On the other hand, any 100% does not even exist in medicine.
Do I have the right, doctor, to say that, if the current success rate is 13 years’ freedom from symptoms in 90% of outcomes, then perhaps, 20 years down the line, it will become 100%?
I don’t know. All I know is that the life expectancy of patients will change. They will have the chance to grow much older, to have increased life expectancy. And I also know that they will have far fewer terrible side effects and enjoy a better quality of life.
Thanks indeed, Dr. CADY, for your time and for how valuable it was. I also know that you are really busy traveling from France. Thank you on behalf of all of the patients whom you have cured, as well as all of those who have diabetes and obesity and can’t wait to have this revolutionary operation that you have successfully practiced over the years.
- Graduated from Sorbonne university, Pierre and Marie Curie, Paris VI France.
- Expert in general medicine.
- D.I.U. in morphological and anti-aging medicine.
- D.U. in medical lasers for aesthetic medicine.
- D.I.U. in Tobacology and helping smoking cessation.
- Teacher of the D.I.U. in Tobacology.
- Member of the administrative council then general secretary of the Tobacology society in 2002-2004.
- Teacher within the university of Tobacology.
Dr. S.T. to Dr. KUPERMINC: Sugar is an attractive enemy. As you know, we eat too much fat, sugar, and salt. The sugar may lead to cirrhosis, which creates a danger of having liver cancer.
Q. Dr. S.T. to Dr. KUERMINC: Do you have diabetes patients who you follow up? How do you imagine the future of these patients—with obesity or without obesity?
The difference between being obese and not being obese is a huge one, because obesity brings discomfort to your life in many ways. It’s very difficult to be obese. It’s heavy. There are additional kilos on one’s body and there is also the stigma vis-à-vis other people. It’s very difficult to be overweight. Since an obese person is considered an incapable person, someone who has no will, our culture projects an image onto that person that has no bearing to that person as a whole, their qualities and capabilities. It’s a disease, not a social state!
Q. Dr. S.T. to Dr. M. KUPERMINC: Cancer cells need energy like all other cells. In other words, we mean glucose. These patients consume on average 20 times the normal amount or more. Do we have to remove sugar to avoid dangerous diseases such as cancer?
Removing, no. Consuming a lower quantity, yes. Sugar is the brain’s fuel; so, if you did not eat sugar, I am not sure you would be able to maintain clear thinking. But there is «slow» and «fast» sugar. The fast sugar is the bad one. Whereas the slow sugars can break down; they will disappear slowly but still benefit your body. So, we have to choose the slow sugars for our alimentary system, not the fast ones.
Q. Dr. S.T. to Dr. M. KUPERMINC: Diabetes is the epidemic of the century: nearly 10% of all people around the world are diabetic, among which 3.5 million are French. Dr. KUPERMINC, you were a living example as you had diabetes and obesity. Could you please share your experience with us? All of us know that your surgeon was Dr. CADY, and he is here with us today.
First of all, I want to thank him because it was a rebirth. I don’t have other words to describe it. This procedure has changed my life and has helped me find myself again. This procedure was the main motivation to take the surgical route. I did not care about being overweight, but having diabetes was the straw that broke the camel’s back. I couldn’t imagine that I would ever be better—I was sick and suffered a multitude of side effects! So, that is what made me make the decision to have the operation. I wanted the diabetes cured and here I am recovered, which is beyond price.
Q. Dr. S.T. to Dr. KUPERMINC: How many kilos had you reached, and how long was it before the benefits of the operation took effect?
Between 20 and 30 years of age, I weighed nearly 48 kilos. But then I became almost quintal. I reached 97 kilos. But today I am 49 kilos once again.
The recovery from diabetes can be fast. I was really surprised that it disappeared and that I am now comfortable and can live an incredible life. I know that obesity has many disadvantages, and that diabetes is a debilitating disease.
The glycemia increases and decreases were uncomfortable. The balance was very difficult to obtain. There were a lot of moments when I felt tired and malaise. When I suffered from hypoglycemia, I was not well. In the past, I have had vision problems due to the diabetes. This was because our sight depends on the level of sugar in our bodies, and at the time I did not understand this.
It was uncomfortable for long periods of time. So this quick transition to a state of wellness seems extraordinary now!
Q. Dr. S.T. to Dr. KUPERMINC: Was your diabetes type 2?
Yes. There are two types of diabetes. Type 1 diabetes is where people manufacture very little to no insulin. The correct treatment in this case is to take insulin.
Type 2 diabetes is when insulin is not manufactured in sufficient quantities. In type 2 diabetes, we can obtain very good results with the surgery. My diabetes was type 2 and it was very developed. My glycemic index had reached a high 3.75g by the time I discovered my condition.
Q. Dr. S.T. to Dr. KUPERMINC: So, your glycemia became normal?
Yes, my levels are now 0.80g, 0.90g, are the numbers just as a result of the operation and without any additional treatment. And the transition was much faster than can be explained just by issue the weight. The surgery, and resulting change, happened my diabetes level was very high. The first two or three months were a period of transition, a period during which levels normalized. Even before I started losing weight post-surgery, my glycemic level went down very quickly – despite the fact that my weight loss, to lose all the excess kilos, took place over a much longer period of time.
Q. Dr. S.T. to Dr. KUPERMINC: I’d like to ask your surgeon a question now. What do you think about this patient who had type 2 diabetes and who has lost nearly 48 kilos?
I was very pleasantly surprised because she was suffering from type 2 diabetes, which could have got worse and needed treatment with insulin. And insulin is not just a straightforward treatment.
What she has said was right. I have carried out the operation on nearly 500 diabetic patients, and the results for them, too, were really surprising.
Q. Dr. S.T. to Dr. KUPERMINC: Does eating too much sweet food and too much fatty food cause obesity?
A lot of sugar and a lot of fats, yes. Obesity is actually due to genetic features and stress. Stress lowers the glycemia (hypoglycemia), and the hypoglycemia leads to the “munchies” and malaise; and when we feel sad, we usually eat. This is good, in a way, because we need to maintain our sugar levels for brain function, but the problem is exacerbated with eating the “fast sugars”. Fast sugars refer to white sugar, such as sweets, which is bad for our brain, but fruits or natural sugar is not bad for the brain – and, in fact, provides the glucose that we all need to a certain degree for our bodies to function.
So, the sugar transforms to fats, and the fats accumulate. For me, the real poison is eating “fast sugar” rather than eating fats. The combination of both is explosive. But if I have to choose one of them as “the villain”, it’s sugar, as it’s sugar that has an addictive side and makes us want to eat more. This is a vicious, terrible cycle that I couldn’t manage. It became difficult. I felt ashamed of myself and dealing with that kind of emotion is an additional problem.
Q. Dr. S.T. to Dr. KUPERMINC: So, is it stress that causes us to consume sugar or is it sugar that causes stress?
It is a little bit of both. For me, the initial trigger was that the stress created a need for sugar. In fact, many patients have said that when they do not feel better, sugar makes them happier. And this is right. But when we take sugar and feel better, we immediately feel guilty. And when this happens, it creates a vicious cycle that we can’t control. It stigmatizes; people are accused of having no willpower. It’s dramatic because it’s wrong. You have to break this cycle, but it is not enough to do this only through diet or taking medication.
Q. Dr. S.T. to Dr. KUPERMINC: Speaking from your personal experience, do you advise people who have diabetes caused by obesity to have the operation?
Yes! Speaking from personal experience, yes! I’m a new person. I’m not who I was before. I was held back by weight. I’m not tired like I was before. I can sit wherever I want. Obesity has many disadvantages and terrible drawbacks: I could not lower my body far enough to sit. I could not respond to what people were asking me to do. My luxury—this will make you laugh—was taking a bath, which was very difficult before.
Now, I can get in and out of the bathtub. Before, I could not take a bath as I could not get out of the bathtub. Having obesity is a huge problem. I couldn’t do anything! My muscles were not adapted to my weight. If you said you wanted to do sports and move your body or weight, your muscles would follow suit. But for someone who has obesity, the muscles cannot make the body do what they want it to do. But now I can live normally.
I feel neither malaise nor exhaustion. Previously, I wouldn’t sit down to drink my coffee if it meant sitting on a chair; it was that bad! I was also not able to travel by plane because I would need to squeeze into my seat. It was terrible. All of these are things we don’t think of; they are things we take for granted, unless we were to stop and examine our daily routines: simple things, such as going into a supermarket. I could see other people talk about me, saying, “What is she doing here?” It was as though others had this opinion of me that meant I was not allowed to buy the things I needed from the supermarket.
Q. Dr. S.T. to Dr. KUPERMINC: What advice do you have for the patients here?
My advice is to start taking care of your diet, early. I have never eaten fast sugars alone. But if you want to eat them, you can from time to time, and you have to consume them after a meal. Fast sugars plus slow sugars are like adding cold water to hot water to make warm water. So, this allows us to dampen things, to mix farinaceous foods and vegetables, because when we have fibers, our bodies will slow down. A dietitian will explain this better than I can, but they will use the same principles.
We don’t offer an operation as the first choice, but only once we’ve exhausted all of the other options. You must do things gradually, and you also have to be ready, as we will not carry out operations for anyone at any time without taking their complete situation into consideration. If there were a psychological condition that makes you want to eat, or is responsible for your problem, then you must solve this problem first. We have to take things one step at a time. I will not do everything right away because I am not prepared to do that. I have to walk down the entire road, starting with the medication, and then, if it is not helping, I am willing to carry out the surgery. But only as a second choice.
Q. Dr. S.T. to Dr. KUPERMINC: After your mini by-pass operation two years ago, you are now back to how you once were: without diabetes and not overweight.
There is another thing that disappeared. I had a sleep apnea. I could not sleep at night. Now there’s been an about-turn, and it’s been gone for a year and a half. Equally, diabetes disappeared immediately. So now the world has opened up and it’s time to experience all that life has to offer. Recovering from two dangerous diseases is a wonder and a spectacular experience.
Dr. KUPERMINC: Thank you so much for your time. And sharing your live experience.
Mrs. AYATI, you are an osteopath and an expert in visceral osteopathy. You’ve written a thesis on the interest of osteopathy in relation to the bariatric surgery of Dr CADY, and, during that time, you aligned your way of working to his team’s best practices. Your discipline allows you to develop the care of obesity and diabetes patients after a mini bypass.
Q. Dr. S.T. to Mrs. AYATI: You come in, primarily, with a protocol to continue the post-operative multidisciplinary approach. Could you please explain more about your exact role to us?
Mrs. AYATI: Because of the operation, the anatomical structure of the body changes, and through its side-effects, the physiology is changed, too. The pressure in many parts of the body, such as the thoracic region and the abdomen, is disturbed. So, the operation affects the points of support situated at the level of the modified articulations. Some pain appears while other pain can disappear, so the importance of my role is to manage these connections that manifest as pain.
The role of the osteopath at this time is very important. On the one hand, osteopathy provides the readjustment needed for the entire body. On the other hand, it limits the post-operative problems, pains, and tensions that may appear later on in a patient’s life.
Q. Dr. S.T. to Mrs. AYATI: And this happens without medication?
Mrs. AYATI: Yes, without medication. I use manual techniques, applied in certain places: viscerals, musculo-skeletal, and joints.
Q. Dr. S.T. to Mrs. AYATI: This is the sole means that you use to treat the patient, i.e. just through the specialist’s use of touch with hands?
Mrs. AYATI: Exactly.
Q. Dr. S.T to Dr. CADY: What do you think about this method?
Dr CADY: It’s magic. And it represents an unknown area in medicine. I’m sure someone will discover that one day. Mrs. AYATI is successful in the pre-operative as much as the post-operative. And this is very surprising—that a physical disease like the gastroesophageal reflux can still be treated simply by the hands. In the past, we cured people in the same way. And I think it’s much better than the medication.
Q. Dr. S.T. to Mrs. AYATI: What you have achieved is wonderful. What is your role after the operation?
Mrs. AYATI: I can come in immediately after the operation to release the patients’ pain when they wake up. The bypass has been carried out by means of a laparoscopy. It injects some air into the body. Sometimes, patients may wake up with pain as a side effect, and they have difficulties when breathing. In those cases, I need to be there immediately.
Q. Dr. S.T. to Mrs. AYATI: If I have understood your role correctly, it’s also preventive, isn’t it?
Mrs. AYATI: Yes, osteopathy is developed in a very positive way to reduce the risk of later complications such as gastroesophageal reflux, transit problems, digestive problems, and pain in the abdomen. I can work on all of these since the organs are connected with each other. And they are connected to the skeletal system throughout the body. Sometimes, when the organs suffer, the patient experiences this as pain. Patients suffer. The medication does not help them. Yet the results of all examinations can appear normal. That is when osteopathy can ‘step in’ and solve the problem.
Q. Dr. S.T. to Mrs. AYATI: I am impressed. Could you please explain for us how you are able to reduce this reflux just with your hands? Dr. CADY gave a small explanation just now. Could you explain for us in more detail?
Mrs. AYATI: The most impactful reflux after the bypass operation usually happens two years’ later, i.e. two years after the operation took place. If we do not control or treat the reflux, it can sometimes lead to a need for surgical intervention. I can read the body. If there are parts that suffer, I detect an abnormality. And, when this is the case, I have my techniques for treating the problems. They remain my secret!
Q. Dr. S.T. to Mrs. AYATI: Absolutely. You have to keep these secrets. How many times do you intervene after the operation?
Mrs. AYATI: It depends. It’s essential to examine the patient in the days after the operation, to know how many times I need to intervene and when. This actually depends on each patient. It can be two times, three times. I personalize each treatment according to the needs of each patient.
Q. Dr. S.T. to Mrs. AYATI: Give me an example of the number of treatments for a normal patient without complications?
Mrs. AYATI: One or two times for patients without complications.
Q. Dr. S.T. to Mrs. AYATI: Until the patient loses weight or can continue on his own?
Mrs. AYATI: It is very interesting to give treatment after weight loss because such rapid weight loss creates many side effects in the body. That’s why, in general, I see the patient twice in the 10 days after the operation, and then at three months and six months later, to follow up with them. We typically accompany the patient throughout this long process.
Q. Dr. S.T. to Mrs. AYATI: To sum up, could we say that you are an essential part of Dr. CADY`s crew?
Mrs. AYATI: If I may, I’ll just go back to a point I forgot to mention: I also work on scars because there are many people who suffer from scars after recovery. These scars create adhesion and this adhesion can disturb the function of the organs, the viscera. There are very accurate techniques to treat the cicatricial zone. I first treat the deep scars, and then the ones on the surface to relax that part of the body. This also improves the visual aspect of the scars.
Q. Dr. S.T. to Dr. CADY: What do you think about the fact that Mrs. AYATI is able to cure patients using only her hands?
Dr. CADY: It is beyond doubt that she does. In fact, I like to use these techniques, too, in helping my patients.
Q. Dr. S.T. to Dr. CADY: So, your patients can really count on you. You can help them across the board?
Dr. CADY: Yes, I can help them across the board.
Dr. S.T. to Mrs. AYATI: Many thanks for joining us for this interview. And our thanks to your hands.
Dr CADY: She does an excellent job.
Q. Dr. S.T. to Mrs. Laura GIAMI: How are you?
Laura GIAMI: Very good, thanks.
Q. Dr. S.T. to Mrs. Laura GIAMI: You worked as a dietitian for many years. Your certificate is French. You are a part of the multidisciplinary group of our great surgeon Dr. CADY, expert on obesity, diabetes, and bariatric surgeries. You play a role both before and after the operation. What is the exact purpose of following up on the nutrition of these patients?
Mrs. Laura GIAMI: The pre-operative is very important with bariatric surgery because we have to teach the patient how to eat again, which means that we have to give them a good system as well as advice on diet and lifestyle changes like eating slowly and not skipping meals. Moreover, they should avoid all sweets and fats, as these are foods that the patient can’t tolerate after the operation. There will be no diet, and there will not be calorie restriction. It’s actually about having a nutritional balance during this time.
Q. Dr. S.T. to Mrs. Laura GIAMI: Is it possible to give us an example, such as the categories of food the patient can and cannot eat? Or, is it the case that the patient can eat all food categories but must change the quantities they consume? Are there any foods that the patient should remove absolutely from their diet?
Mrs. Laura GIAMI: About the quantities: In the pre-operative stage, we must not change them. We don’t care if the patient is hungry or if that leads to a nibbling problem. We just have to offer him three meals each day, and we may add snacks, if needed, without any fats (fried food, for example) or snacks rich in carbohydrates. We have to try to measure the protein, the carbohydrates, and the greens. We should also avoid cake, cream, or things like that – just for the time period after the operation when their taste buds are not used to sugar and fats.
Q. Dr. S.T. to Mrs. Laura GIAMI: Overall, looking at the large number of patients whom you’ve treated, do they tend to respect what you say?
Mrs. Laura GIAMI: In general, yes, because the object is to keep them better after the operation.
Q. Dr. S.T. to Mrs. Laura GIAMI: The mini bypass, as we know, is a reversible operation that has two objectives. Could you explain for us what these two goals of the mini bypass operation are?
Mrs. Laura GIAMI: With a bypass, we have two techniques: the first one is the alimentary restriction. The patient cannot eat the dishes they used to eat before the operation. It becomes equivalent to a pot of yogurt replacing the size of the patient’s previous meal. They can’t eat more. Their stomach will say, “Stop!” So, we have to break down the nourishment to having three meals each day and two or three snacks. At the beginning, the patient must eat every two or three hours. He cannot eat all his food allowance in one go. So, this is the first technique. The second one is malabsorption. Dr. CADY created the short-circuit in place of the intestine and the stomach, and this allows for the malabsorption. If the patient eats more, he will not be able to digest the food and the absorption, in this case, will lead to weight loss.
Q. Dr. S.T. to Mrs. Laura GIAMI: Could you give us a menu of the types of food for the day (breakfast, lunch, snacks, etc.) required at the beginning?
Mrs. Laura GIAMI: Okay. Let’s call the “beginning” period the first three weeks, for example. During this time the patient has to eat two biscuits for breakfast. They cannot eat more. There has to be a half-hour interval between eating and drinking. So, the patient must wait for half an hour after eating before they can have a tea or coffee. One or two hours later—and in this intervening period of time, he cannot eat or drink anything—he can eat stewed fruit. Then, nothing more. At lunch time, the patient can have either a small slice of meat or fish with a small apple or a coffee-spoon-size of greens. Their stomach will be full after that. One or two hours later, the patient can eat yogurt. Later, dinner comprises protein, an apple, and a spoon of vegetables.
In general, the patient respects that regime.
Q. Dr. S.T. to Mrs. Laura GIAMI: Could you give us details about your role after the operation?
Mrs. Laura GIAMI: After the operation, the patient must not eat food that has fiber for the first three weeks, until the interior is totally healed. So, all food must be mixed or mashed. The patient cannot eat raw food. They can’t eat anything that is raw because it is very difficult to digest. And as I have explained before, they are obliged to break down their nutritional routine into slots and eat every two or three hours. After these three weeks, when the healing is done, the patient can start eating all things but in very small quantities. We reintroduce raw food, fruit, carbohydrates (pasta, for example), cheese, etc.
The patient can eat all of those things but only in very small quantities. And the patient is not allowed to go beyond satiety. If they do, they will start vomiting. They will be blocking food and they will be sick. The bypass contributes to that because there will be an alimentary restriction where the bypass begins. Otherwise, they will have “dumping syndrome”. It causes discomfort if patients just eat a huge amount of fats and sweets or if they eat very fast. That’s why the pre-operative phase is important. We avoid fats and sweets, so after the operation everything proceeds in a good way and the patient doesn’t face “dumping syndrome”.
Q. Dr. S.T. to Mrs. Laura GIAMI: Why could the fats cause “dumping”? All that we know is that this person ate a large amount of fats before the operation?
Mrs. Laura GIAMI: It’s due to the malabsorption effected by the bypass…
Dr. CADY: … and due to the digestive juices, that arrive very quickly in the intestine, which is not ready to receive them.
Q. Dr. S.T. to Mrs. Laura GIAMI: How many times do you see the patients before and after the operation, in relation to the nutritional regime that you described?
Mrs. Laura GIAMI: Before the operation, I try to see them every three and six months to teach them how to eat. After that, it depends on the type of patient and how they used to eat before the procedure. So, in terms of follow-up, I try to see them a month after their operation—and then again at three months and six months afterwards. Then, I try to see them once each year on the anniversary date of the operation. And by doing that, I can keep monitoring them and ensure that they do not become overweight in the following years.
Q. Dr. S.T. to Mrs. Laura GIAMI: Thank you for your time and for answering our questions. I can see that your role as a dietician is very important in Dr. CADY’s team. And it is wonderful that the patients can respect the protocol and be informed about the food that they must focus on. Looking at your time working alongside Dr. CADY, what is the average number of kilos that your patients succeed in losing?
Dr. S.T.to Dr. CADY: I think that a patient who once weighed 185kg lost half of that weight.
Dr. CADY: Yes, in general, my patients tell me that we have “cut them in two”. And they do not forget that I cured them from diabetes by this process (the gastric bypass)—even more quickly than the loss of weight.
Dr. S.T. to Mrs. GIAMI: Many thanks for joining us for this interview