Kandace Kichler, MD: Gut Hormones, How Metabolic Surgery Works & Weight Loss

by Mike Mutzel



About Dr. Kandace Kichler, MD

Dr. Kandace Kichler is a board certified General Surgeon with Fellowship training in Minimally Invasive and Bariatric Surgery. She is the Medical Director of Bariatric Surgery at JFK Medical Center in Atlantis, Florida. She is also an Associate Professor in Surgery at the University of Miami Miller School of Medicine.




Products and Books Discussed:

Enrollment for July's Autophagy Enhancer eClass:

Costantino, S., & Paneni, F. (2019). GLP-1-based therapies to boost autophagy in cardiometabolic patients_ From experimental evidence to clinical trials. Vascular Pharmacology, 115, 64–68.

GLP-1-based therapies on PVAT autophay and vascular function in obesity. PVAT, perivascular adipose tissue.


Key Time Stamps and Show Notes:

03:53 Bariatric surgery brings quick resolutions to type 2 diabetes reversal, changes in cardiovascular health, and sleep apnea. It is more of a metabolic surgery. Excess weight will come off in the first year to year and a half after bariatric surgery.

05:08 Diabetes and sleep apnea are most often resolved before the loss of weight after surgery. There are more mechanisms as play than just weight loss.

06:41 Dr. Kichler tried to stay full keto after the recent birth of her baby and during breastfeeding, but found that she needed some carbs for milk production and energy.

07:39 Diet and exercise are the foundation for everything that you need. Some of us are not successful with this and bariatric surgery may be a viable option.

08:06 A good candidate for this surgery is someone who is morbidly obese or has a severe medical problem/co-morbidity.

08:55 Diet and exercise need to be in place after surgery, or the weight can be put back on.

09:12 Insurance companies have qualification parameters. Often the BMI start point is 35 BMI. You would need to be severely obese or obese with a medical problem.

09:57 The cost of the procedure is between $10,000 – $30,000. Insurance will cover most of the costs.

12:00 There are some prescription medications for patients who did not use diet and exercise after the procedure and need to lose some weight. These medications have had limited success and are used on a limited basis.

12:15 It may be possible to do a second different procedure for better success if there is a complication from the procedure or lack of weight loss. This is rare.

12:55 Our organs look fatty. The liver might look enlarged, congested and pinkish. Omental fat that covers our organs is thick. Mesentery fat, which surrounds your intestines is often engorged and may have swollen lymph nodes.

14:28 Patients should go on a low-calorie diet, almost liquid diet, 2 weeks before surgery to help shrink the liver and omental and mesentery fat.  This is a safety measure.

17:15 Patients have extensive workups, doctor visits and see a nutritionist and psychologist prior to surgery.

17:49 The lap band has fallen out of favor. It has proven to be not as effective, losing only 30 to 40% of excess weight. It has complications. Forty to 50% of people need to have it removed.

18:44 Most patients are offered either a sleeve gastrectomy or a gastric bypass. The sleeve is simpler and does not alter intestinal anatomy with similar effects.

19:31 Gastric bypass is reserved for someone who has been a diabetic for several years, someone who has significant cardiovascular disease or someone who has a higher BMI. The bypass is a little better for weight loss and diabetes than the sleeve.

20:02 The sleeve equates to stomach stapling. They remove a portion of your stomach and divide it to a smaller banana-shaped stomach. It has a smaller capacity and the food you eat empties quicker. It is not reversible.

21:09 With gastric bypass, the stomach is divided in a different area and it is made into a small pouch, about the size of a large hard-boiled egg. The remainder of your stomach is left in your body sitting on the sidelines. Some of your small intestine is rerouted so your small stomach pouch attaches to your jejunum. The restriction and fast transit cause the changes. With gastric bypass will receive the proper hormones and enzymes that affect fat metabolism, but not until later.

24:45 Most bariatric surgery that Dr. Kichler does is laparoscopic or robotic, minimally invasive. You will find few adhesions that are common after a traditional open operation.Someone with Crohn’s disease or ulcerative colitis have significant intestinal inflammation and could have adhesions, but they would not be candidates for these surgeries.

27:57 The efficacy of bariatric surgery weight loss is from malabsorption, metabolic changes and restriction.

28:30 Bariatric surgery decreases gut permeability and increases your production of toxic metabolites.

29:51 A large number of patients have no complications.Risks include direct surgical risks. Long term complications would be strictures (narrowing) from scaring. Ulcers may form after gastric bypass where the stomach and small intestine meet.

34:38 The degree of weight loss or benefit from Metformin not nearly as great as surgery.

39:57 Obesity is not just from over eating or food addiction, but can be from genetics, the environment, the foods eaten, inherited disorders.

41:55 What you feed your kids is paramount to their health and weight in the long run. Infant formulas can have a main ingredient of corn syrup. If a child is obese in toddler years, the chance of being an obese adult is extremely high. Go organic, limited processed foods.

43:53 In 1990 the percentage of people who suffered from obesity was 5 to 10% in most states. Today it is 40 to 60%.

49:31 High protein consumption that you should incorporate before and after any surgery. You want to be at your maximal nutritional state.

50:10 People who are exercisers before and after surgery recover faster.

59:24 Dr. Kichler’s elevator speech on obesity: The impact of industry and financial sectors on our nutritional recommendations and what is farmed is horrible and should be changed from the ground up.

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