Hello.
Hello.

I’m Dr. Amrita Kamat, the acting associate chief of staff for research at
I’m Dr. Amrita Kamat, the acting associate chief of staff for research at

the South Texas Veterans Healthcare System.
the South Texas Veterans Healthcare System.

This year we are celebrating 96 years of research at the VA and I want to
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
introduce you to some of the excellent research work that is being performed

here at our own VA.
here at our own VA.

We have over 250 projects in diverse areas of research including the basic
We have over 250 projects in diverse areas of research including the basic

sciences, rehabilitation health sciences, and clinical sciences using the
sciences, rehabilitation health sciences, and clinical sciences using the

state-of-the-art technology like human gene therapy all aimed at improving
state-of-the-art technology like human gene therapy all aimed at improving

the quality of our Veterans’ lives.
the quality of our Veterans’ lives.

Please enjoy this video as we highlight some of the current projects
Please enjoy this video as we highlight some of the current projects

performed by researchers right here at the South Texas VA.
performed by researchers right here at the South Texas VA.

Thank you [Music]
Thank you [Music]

So I’m a translational researcher.
So I’m a translational researcher.

I’m an endocrinologist by training and I do
I’m an endocrinologist by training and I do

study in diabetes and obesity and I really actually do physiological studies to
study in diabetes and obesity and I really actually do physiological studies to

understand how the body handles the glucose.
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 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
this was the position that was available and I was extremely interested in

moving in.
moving in.

So the current research project which is the extension of my work for the last
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
15 years, is to understand how reforming the gut changes the glucose

metabolism.
metabolism.

Diabetes and obesity are two main public health conditions and Veterans,
Diabetes and obesity are two main public health conditions and Veterans,

they have diabetes much more prevalent than the background population.
they have diabetes much more prevalent than the background population.

These conditions are troublesome because they cause so much of the
These conditions are troublesome because they cause so much of the

problem.
problem.

They create actual cardiovascular disease, cancer, many other comorbidities.
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.
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
So to date, one of the most effective treatments for obesity is weight loss

surgery.
surgery.

We don't understand why, so my research is about understanding how
We don't understand why, so my research is about understanding how

replanting the gut can change the glucose metabolism, improve diabetes.
replanting the gut can change the glucose metabolism, improve diabetes.

Whatever helps you helps others so um, you should you should volunteer for
Whatever helps you helps others so um, you should you should volunteer for

stuff like this you know?
stuff like this you know?

As long as it's not going to affect your body itself, I
As long as it's not going to affect your body itself, I

think it's good.
think it's good.

This research unit has been serving the investigators in many different fields
This research unit has been serving the investigators in many different fields

for the last 40 years.
for the last 40 years.

So it actually has given me opportunities to be able to do these
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
kind of a state of art physiological studies and be able to help the Veterans

as well.
as well.

So I see patients as endocrinologists here, and there are so many referrals
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
that they come to see, because of glucose abnormalities after these bariatric

surgeries.
surgeries.

And it's extremely, extremely unique across the nation to have the
And it's extremely, extremely unique across the nation to have the

opportunity to be able to evaluate these Veterans first hand
opportunity to be able to evaluate these Veterans first hand

And is extremely beneficial for their clinical care to be able to do that.
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
Basically, we know that about 70% of Veterans are overweight or obese

and obesity is associated with cardiometabolic disease which are things like
and obesity is associated with cardiometabolic disease which are things like

type 2 diabetes and cardiovascular disease.
type 2 diabetes and cardiovascular disease.

And so we know when we do research studies that we can get people to lose
And so we know when we do research studies that we can get people to lose

um weight actually pretty easily.
um weight actually pretty easily.

uh If, if we do these you know targeted interventions and that five percent
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
weight loss is associated with improvements in both your diabetes and

cardiovascular disease risk.
cardiovascular disease risk.

But what we're not good at is getting people to maintain that.
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
And so this intervention is really about trying to get individuals to be able to

maintain weight loss successfully.
maintain weight loss successfully.

So we are doing that with what we call intermittent fasting and that is um
So we are doing that with what we call intermittent fasting and that is um

restricting your calories for specific periods of time.
restricting your calories for specific periods of time.

And what I mean is uh when the individuals will be in this study some
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
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
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
involve they'll only eat about 500 calories but they will do it um only one day

a week.
a week.

And so that's really helpful for them because if you're dieting still but only
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.
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
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
reduced rate than somebody who had just done the usual care group from a

day-to-day perspective.
day-to-day perspective.

The research testing we do things like test individuals risk for diabetes which
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
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
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.
women have gestational diabetes when they're pregnant.

We are doing functional testing so things like your balance and your strength
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
so we'll find out the maximum amount of weight that people can lift at one

time.
time.

We also will do a stress test, um we do a test called a resting metabolic rate
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
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
day long without eating without moving, how many calories do you need to

just be alive?
just be alive?

And then we can figure out from your fitness levels and your activity, how
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
many calories you need in order to actually lose weight so it's very

individualized in that aspect of it.
individualized in that aspect of it.

We are doing so the optional procedure that he may have been mentioning is
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
a muscle biopsy and so we are actually taking a little snippet of muscle in

individuals who are willing.
individuals who are willing.

So that, thankfully is an optional procedure.
So that, thankfully is an optional procedure.

We're doing body composition so we will do a dexa scan which allows us to
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
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
at your fat and muscle and its relationship and where it's kind of located

throughout the body.
throughout the body.

Once somebody signs the consent form, they will be in this study for about
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.
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
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
exact same testing again, then they go through six months of weight

maintenance and then they go through the testing again.
maintenance and then they go through the testing again.

So all the procedures they do they do three different time points um and
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.
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,
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
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
value our volunteers in order to be able to make decisions for medical care in

the future.
the future.

And so this would potentially drive clinical guidelines when it comes to
And so this would potentially drive clinical guidelines when it comes to

weight loss and weight maintenance which again, considering that over 70
weight loss and weight maintenance which again, considering that over 70

percent of Veterans are overweight and obese, could really change their
percent of Veterans are overweight and obese, could really change their

clinical care.
clinical care.

The San Antonio GRECC over the last 15 to 20 years has made major
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
discoveries in the basic mechanisms of aging and has identified novel agents

that can improve aging in animal models.
that can improve aging in animal models.

And now what we've embarked on over the last five to seven years or so is
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
translating these discoveries from the bench to the bedside so now we have

several studies including the metformin trial to examine different
several studies including the metformin trial to examine different

pharmacologic interventions and what their impacts are on human aging
pharmacologic interventions and what their impacts are on human aging

including physical function, quality of life, and frailty.
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
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,
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
knowing about bone density also made this study very interesting for me

because it's very relevant.
because it's very relevant.

I’m concerned, you know, my weight is an issue, over the years I saw my a1c
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
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.
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
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
study done and to see what is happening with your glucose over a three hour

period.
period.

It made it real for me.
It made it real for me.

In other words, it was like the realization is like this is a real
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
situation that I have to get under control for the quality of my future life, you

know?
know?

You know I think most Americans are somewhat in denial but the average
You know I think most Americans are somewhat in denial but the average

lifespan in the United States is 79.
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
So I want the next 10 to 14 years of my life to be as good as they can be

health-wise.
health-wise.

And so this study has been a huge, a huge eye-opening experience for me.
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
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
several multi-site clinical trials ongoing and we are very excited in the last

few months, we've launched the preventable trial here in
few months, we've launched the preventable trial here in

San Antonio.
San Antonio.

And here at this VA it is a clinical trial of atorvastatin for the prevention of
And here at this VA it is a clinical trial of atorvastatin for the prevention of

dementia and disability in healthy older adults.
dementia and disability in healthy older adults.

So we're actively recruiting for that study as well, and we are one of about a
So we're actively recruiting for that study as well, and we are one of about a

hundred sites across the United States.
hundred sites across the United States.

I’m just very impressed with the Audie Murphy's VA hospital environment.
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
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
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.
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
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
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
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
whole process of interacting with the human participants on our clinical

trials.
trials.

It's just very personally and professionally very satisfying and gratifying and
It's just very personally and professionally very satisfying and gratifying and

also working with the team of nurses and research assistants and other
also working with the team of nurses and research assistants and other

healthcare professionals here in the Bartter Research Unit and also members
healthcare professionals here in the Bartter Research Unit and also members

on my team.
on my team.

It's just it's a lot of fun every day.
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
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
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
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.
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,
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
to understand what we do, what we do and they are

extremely important to the whole process.
extremely important to the whole process.