Weight Loss surgery will
basically render very obese people, less obese, writes Dr Louis Flancbaum.
Do not hold unrealistic hopes as far as how "thin" you will be after this
surgery - it is done for health rather than looks.
Some patients have a lot of loose skin
after a quick weight loss and may feel that for comfort, they need plastic
surgery. Plastic surgery is sometimes covered by insurance and
sometimes not.
A
stapled stomach produces very little acid (this
is on purpose to avoid esophageal reflux) which means that protein is not
well digested (the enzyme which digests protein needs to work in stomach
acid) and also, bacteria may not be killed before the food is absorbed in
the blood stream. Large amounts of bacteria entering the blood
stream from the intestines can cause a lot of problems in the body
including auto immune illness like joint disease, and rheumatoid
arthritis.
The
bypassed stomach can still produce acid but it is not neutralized
by the duodenum since the action of the duodenum to neutralize requires the
presence of food. Thus the acid may go into the small bowel. Ulcers in
the small bowel especially in longer term gastric bypass patients are
common. These can be hard to find, hard to fix and cause leaks, and
bowel obstructions.
Some post ops who are four and five years
out from surgery, do stay fairly thin without dieting and exercise but only because
they have a lot of physical problems. Be careful that you
aren't exchanging one set of problems for another.
Most people feel that thin and ill is not preferable to being
fat and healthy.
Weight Loss Surgery will not fix
depression. As a matter of fact, prolonged starvation
(which you will experience, eating 500-1000 calories a
day and not absorbing much in the way of nutrients) has
been observed to cause depression. A high percentage of
marriages break up after Weight Loss Surgery. Also, the chronic pain which
some Weight Loss surgery patients suffer can contribute to depression.
Any quick weight loss is
considered "extreme dieting" which means a very low nutritional intake.
This type of weight loss, while very attractive to members of an "instant"
society who wish things RIGHT NOW, does have its side effects. For one, your body sets your
metabolism way down making it harder to keep the weight off after the
first year. Your body does this by cannibalizing it's
own muscles and even parts of organs. There is a growing
body of evidence that starvation can cause brain damage
and a lessening of mental abilities as well. This would
make sense as the cognitive areas of the brain are not necessary to maintain
life. (See the studies of the Institute of Food Research, UK -
studies are not on line but they will send these if you request)
The
media tells us that the gastric bypass is a new surgery and that's why
they don't have statistics on longevity and other issues - but, it is NOT
new. Gastric bypasses have
been done for 40 years yet we have access to little to no statistics on
long term results.
- "Well, the gold standard in medicine is the controlled clinical trial.
We don’t go subjecting 100,000 people to a surgical procedure without doing
a controlled clinical trial or dozens of clinical trials, and then looking
at the results. Do you know how many clinical trials have been published on
weight-loss surgery or gastric bypass? Zero. None of them have compared it
to clinical conservative treatment and found it to be superior for life
expectancy or for anything else other than, you know, risk factors. A number of trials have been started, and the final results have never
been reported. We have to ask, you know, why haven’t we seen the final results?
I think it’s because it’s bad news."
Dr Paul Ernsberger, PHD (Case Western
Reserve School of Medicine) on the Donahue Show on obesity surgery
The inventor of the gastric
bypass, Dr Edward Mason, has expressed concerns about the gastric bypass
because of vitamin deficiency and advocated a surgery called the VBG which
did not include any shortening of the small gut.
Many Gastric bypass patients do
not digest Vitamin B12 and need to take B12 shots, at least once a month.
If you don't take these, you may get symptoms like numbness of the hands,
feet and legs ("peripheral neuropathy"). A long term deficient in Vitamin
B12 can cause auto immune disease and pernicious anemia. Make sure you are
careful about watching for symptoms which can show up before your blood work
shows a shortage.
The gastric bypass is, for all
practical purposes, not reversible. The digestive system
is permanently changed in weight Loss surgery. Some of it can be
fixed (called a 'take down') but the patient will suffer repercussions for
the rest of his/her life and the takedown surgery is as dangerous or more
so than the original surgery. So be very
sure of what you are doing before you make this decision.
(Note: The Adjustable Band is reasonably reversible although, in time -
2-5 years, some damage
to the stomach may be done by the band.)
You
will not die in five years if you don't have Weight Loss Surgery!
No research to date shows that obesity alone, is a risk factor. The
risk factor on having a BMI over 40 is generally thought to be like being a
light smoker. (reduce life span by 5 years so that means you may only
live to 73 instead of 78)
Living a sedentary lifestyle is a risk factor but no matter how large a
person is, they can begin to exercise (water aerobics, cycling and walking
are good exercises for larger people). Many large people have said
"no" to Weight Loss surgery and have long outlived their friends
that did have the surgery.
It may be true that as they say, that Weight loss surgery is the only
way to permanently lose weight as the ads tell us.
However, it is a tool which doesn't work for everyone and there are no
guarantees that the risks you are taking with having surgery are going to
result in a permanent weight loss. More importantly, there is a
growing body of evidence to suggest that we can only vary our bodyweight 10
percent below our setpoint (20-40 lbs) without fighting total daily wars
with our bodies. This is because the body is a complex and automated
system and will produce hormones and change in other ways to stop weight
loss or cause a gain WITHOUT US DOING ANYTHING if it senses it's at -what it
considers- an unhealthy weight. This is even true with patients who
have HAD bariatric surgery. So when you consider surgery, keep in mind you
may only be looking at keeping off 30-50 lbs in the long run which you can
do without surgery also. Weight Watchers states that losing 10
percent of your present bodyweight is enough to reduce health risks by 95
percent and you can do that without surgery.
The
Duodenal Switch is a newer surgery than the gastric bypass and the
stomach stapling part has some advantages over the gastric bypass:
(1) DS patients may have less intestinal ulcers because the stomach is
made into a pouch and retains the natural arrangement with a few inches of
the first part of the small bowel still connected (i.e. no 'bypassed
stomach' to dump raw acid into the small bowel). However, it should
be noted that 70-90 percent of the stomach is REMOVED OUT OF THE BODY in this
surgery so if the 10-20 percent of stomach you have left develops ulcers or
necrosis, you can totally lose your stomach. (I have met two such patients
who have lost their stomachs after this surgery went wrong). (2) You
have more leeway about what you can eat - most DS patients don't dump after
eating sugar and most can eat more veggies than can gastric bypass patients. But this surgery can have its darker side. It is done with a BPD which
was a variation of the old intestinal bypass. The BPD shortens the small
gut considerably and as such, can cause kidney stones, liver failure and
"bacterial overgrowth" (part of the small gut gets obstructed and starts to rot). Bottom line, when a DS "goes bad" it's not
pretty! :)
Evidence exists that the absence of bile and pancreatic
juice, the shortness of the gut, the protein malnutrition, and possibly the
presence of undigested food in the colon are all factors predisposing to
bacterial overgrowth.
(DS/BPD - Marceau, Surg Clin North Am - 01-Oct-2001; 81(5):
1113-27)
Some feel that long term protein malnutrition
is also a danger with the BPD:
The BPD and the duodenal switch involve permanent removal
of part of the stomach and bypassing of a large amount of intestine. It is
more radical than the original intestinal bypass operation that was
abandoned many years ago. BPD is associated with horrific side effects
including kwashiorkor. It takes several years for the body to be fully
depleted of stored nutrients so most likely recent post ops have not been
affected yet. DS patients should be followed by a gastroenterologist.
Paul Ernsberger, PhD, Department of Nutrition, Case
Western Reserve School of Medicine, 10900 Euclid Ave., Cleveland, OH
44106-4906 Web address:
http://www.cwru.edu/med/nutrition/ernsberger.htm
Email: pre@po.cwru.edu ; FAX: (216) 368-6644
Some patients get loose bowels with the BPD
(several soft bowel movements a day)
Listing
of jejuno-ileal bypass complications:
Mineral
and Electrolyte Imbalance:
- Decreased
serum sodium, potassium, magnesium and
bicarbonate.
- Osteoporosis
and osteomalacia secondary to protein depletion,
calcium and vitamin D loss, and acidosis,
Protein
Calorie Malnutrition:
- Hair
loss, anemia, edema, and vitamin depletion
Cholelithiasis:
Enteric
Complications:
- Abdominal
distension, irregular diarrhea, increased flatus,
pneumatosis intestinalis, colonic
pseudo-obstruction, bypass enteropathy, volvulus
with mechanical small bowel obstruction.
Extra-intestinal
Manifestations:
- Arthritis
- Acute
liver failure may occur in the postoperative
period, and may lead to death acutely following
surgery.
- Liver
disease, occurs in at least 30%
- Steatosis,
"alcoholic" type hepatitis, cirrhosis,
occurs in 5%, progresses to cirrhosis and death
in 1-2%
- Erythema
Nodosum, non-specific pustular dermatosis
- Weber-Christian
Syndrome
Renal Disease: (in other words, kidney disease and kidney
failure)
- Hyperoxaluria,
with oxalate stones or interstitial oxalate
deposits, immune complex nephritis,
"functional" renal failure.
Miscellaneous:
- Peripheral
neuropathy, pericarditis. pleuritis, hemolytic
anemia, neutropenia, and thrombocytopenia.
If you join one of the post
operative support groups, you will indeed see several people
with the above complications. The longer ago they had the
surgery, the more complications seen. You will also see some
of those people say that their complications are not because
of the Weight Loss Surgery, even though what they are
describing is listed as one of the side effects of WLS. Some
people are in denial about the cause of their physical
problems, perhaps because it would be too painful to wonder whether they made
the right decision to have the surgery.
As with all things, take time with your
decision. You can always have the surgery at a later date
when you have a greater comfort level about it. It is entirely
possible that in the near future there may be a medication obese individuals
can take which will work directly on the appetite centers. The
billroth II, the surgery from which the gastric bypass was invented, is not
done anymore because the condition of duodenal ulcers is now treated with
medications.
Weight Loss surgery is a miracle for some,
for others, the tradeoffs are worth the results and for still others, it can be a
disaster. It is serious invasive surgery and all factors should be
considered. The idea behind weight loss surgery is that although it IS a
painful risky solution, it can be LESS painful or risky than remaining
clinically obese. Each person must decide for themselves if they feel
they would benefit from this solution.
These books are helpful:
Weight Loss Surgery a Lighter Look at a
Heavy Subject
by Terry Simpson, MD
Dr Simpson, a Bariatric Surgeon who has done
thousands of WLS procedures has written what is probably the most
authoritative book on the subject. The book is illustrated and written
in a readable style with Dr Terry's own brand of humor throughout.
More information or order
book
I
Want To Live - Gastric Bypass Reversal by Dani Hart
Dani Hart takes you on her journey through Weight Loss Surgery (RNY gastric
bypass) and the reversal.
See more information or
order book
Doctor's Guide To Weight Loss Surgery
by Dr Louis Flancbaum et al
Very
pro surgery but pretty honest about the risks etc
See more info or order book