Hello.
I’m Dr. Amrita Kamat, the acting associate chief of staff for research at
the South Texas Veterans Healthcare System.
This year we are celebrating 96 years of research at the VA and I want to
introduce you to some of the excellent research work that is being performed
here at our own VA.
We have over 250 projects in diverse areas of research including the basic
sciences, rehabilitation health sciences, and clinical sciences using the
state-of-the-art technology like human gene therapy all aimed at improving
the quality of our Veterans’ lives.
Please enjoy this video as we highlight some of the current projects
performed by researchers right here at the South Texas VA.
Thank you [Music]
So I’m a translational researcher.
I’m an endocrinologist by training and I do
study in diabetes and obesity and I really actually do physiological studies to
understand how the body handles the glucose.
This is one of the best places in the nation so when I was looking for a job,
this was the position that was available and I was extremely interested in
moving in.
So the current research project which is the extension of my work for the last
15 years, is to understand how reforming the gut changes the glucose
metabolism.
Diabetes and obesity are two main public health conditions and Veterans,
they have diabetes much more prevalent than the background population.
These conditions are troublesome because they cause so much of the
problem.
They create actual cardiovascular disease, cancer, many other comorbidities.
But at the same time, there is not actually a cure for any of these conditions.
So to date, one of the most effective treatments for obesity is weight loss
surgery.
We don't understand why, so my research is about understanding how
replanting the gut can change the glucose metabolism, improve diabetes.
Whatever helps you helps others so um, you should you should volunteer for
stuff like this you know?
As long as it's not going to affect your body itself, I
think it's good.
This research unit has been serving the investigators in many different fields
for the last 40 years.
So it actually has given me opportunities to be able to do these
kind of a state of art physiological studies and be able to help the Veterans
as well.
So I see patients as endocrinologists here, and there are so many referrals
that they come to see, because of glucose abnormalities after these bariatric
surgeries.
And it's extremely, extremely unique across the nation to have the
opportunity to be able to evaluate these Veterans first hand
And is extremely beneficial for their clinical care to be able to do that.
Basically, we know that about 70% of Veterans are overweight or obese
and obesity is associated with cardiometabolic disease which are things like
type 2 diabetes and cardiovascular disease.
And so we know when we do research studies that we can get people to lose
um weight actually pretty easily.
uh If, if we do these you know targeted interventions and that five percent
weight loss is associated with improvements in both your diabetes and
cardiovascular disease risk.
But what we're not good at is getting people to maintain that.
And so this intervention is really about trying to get individuals to be able to
maintain weight loss successfully.
So we are doing that with what we call intermittent fasting and that is um
restricting your calories for specific periods of time.
And what I mean is uh when the individuals will be in this study some
of them will be randomized so flip of a coin to either usual care which is all
right, you've lost weight, now maintain it and or intermittent fasting which will
involve they'll only eat about 500 calories but they will do it um only one day
a week.
And so that's really helpful for them because if you're dieting still but only
one day a week which is a little bit more manageable.
And our goal is that we will be able to maintain their body weight at a
reduced rate than somebody who had just done the usual care group from a
day-to-day perspective.
The research testing we do things like test individuals risk for diabetes which
we do with a test called an oral glucose tolerance test and many women may
be familiar with this because we often will do it if we're interested in seeing if
women have gestational diabetes when they're pregnant.
We are doing functional testing so things like your balance and your strength
so we'll find out the maximum amount of weight that people can lift at one
time.
We also will do a stress test, um we do a test called a resting metabolic rate
and this basically allows us to say if you came in and you were just laying all
day long without eating without moving, how many calories do you need to
just be alive?
And then we can figure out from your fitness levels and your activity, how
many calories you need in order to actually lose weight so it's very
individualized in that aspect of it.
We are doing so the optional procedure that he may have been mentioning is
a muscle biopsy and so we are actually taking a little snippet of muscle in
individuals who are willing.
So that, thankfully is an optional procedure.
We're doing body composition so we will do a dexa scan which allows us to
look at your bone density, and we're doing a CT scan which allows us to look
at your fat and muscle and its relationship and where it's kind of located
throughout the body.
Once somebody signs the consent form, they will be in this study for about
11 to 12 months total and that involves about a month of baseline testing.
And then they go through 12 weeks of weight loss, then they go through the
exact same testing again, then they go through six months of weight
maintenance and then they go through the testing again.
So all the procedures they do they do three different time points um and
yeah, so total it will be about 11 to 12 months that they'll be in the study.
The way we make clinical guidelines is often based upon research and so,
that would be the number one thing, is that we need volunteers and we really
value our volunteers in order to be able to make decisions for medical care in
the future.
And so this would potentially drive clinical guidelines when it comes to
weight loss and weight maintenance which again, considering that over 70
percent of Veterans are overweight and obese, could really change their
clinical care.
The San Antonio GRECC over the last 15 to 20 years has made major
discoveries in the basic mechanisms of aging and has identified novel agents
that can improve aging in animal models.
And now what we've embarked on over the last five to seven years or so is
translating these discoveries from the bench to the bedside so now we have
several studies including the metformin trial to examine different
pharmacologic interventions and what their impacts are on human aging
including physical function, quality of life, and frailty.
So when I saw this study, I saw it online, it was perfect for me because at my
age, and I’ve retired, I’ve just turned 65, frailty is an issue and, of course,
knowing about bone density also made this study very interesting for me
because it's very relevant.
I’m concerned, you know, my weight is an issue, over the years I saw my a1c
creeping up along with my weight, and when my primary care physician gave
me the diagnosis of pre-diabetes, that's what qualified me to join this study.
So it's been an eye-opening experience especially to have the first glucose
study done and to see what is happening with your glucose over a three hour
period.
It made it real for me.
In other words, it was like the realization is like this is a real
situation that I have to get under control for the quality of my future life, you
know?
You know I think most Americans are somewhat in denial but the average
lifespan in the United States is 79.
So I want the next 10 to 14 years of my life to be as good as they can be
health-wise.
And so this study has been a huge, a huge eye-opening experience for me.
Many of these trials are investigator initiated single site but we also have
several multi-site clinical trials ongoing and we are very excited in the last
few months, we've launched the preventable trial here in
San Antonio.
And here at this VA it is a clinical trial of atorvastatin for the prevention of
dementia and disability in healthy older adults.
So we're actively recruiting for that study as well, and we are one of about a
hundred sites across the United States.
I’m just very impressed with the Audie Murphy's VA hospital environment.
You know, it's just, and I, you know I really thank them for allowing the
National Health Institute and Dr. Espinoza, you know use these facilities for
the study because I think a lot of people are going to be helped.
I don't even know how to put it into words; it's just very exciting but not only
the science but also interacting with these older Veterans and getting to take
part in their lives and working with them and learning from them and just the
whole process of interacting with the human participants on our clinical
trials.
It's just very personally and professionally very satisfying and gratifying and
also working with the team of nurses and research assistants and other
healthcare professionals here in the Bartter Research Unit and also members
on my team.
It's just it's a lot of fun every day.
So I loveit, the research activities that are being done in the research unit, if
they go from diabetes and obesity like my research, to age frailty, posttraumatic
syndrome, spinal cord injury, and all of this research are going to
be adding to what we know and how we are changing the clinical care.
So that's the communication that I'm going to start having with the Veteran,
to understand what we do, what we do and they are
extremely important to the whole process.