A Gastric Bypass is not only a
'stomach stapling' as the media is fond of calling it.
It's also an intestinal bypass. In a proximal bypass (like Carnie Wilson
had), only about 20 inches of small intestine is bypassed
but that includes the Duodenum in which most of the
absorption of vitamins and minerals takes place. This
means that even with a small amount of intestine
bypassed, the post op might develop vitamin and mineral
deficiencies.
Calcium deficiency: The only place the body can take in calcium
is in the duodenum part of the small intestine - this is
totally bypassed in all gastric bypasses except the
'duodenal switch' (in which 2 inches are left - probably
not enough to do any more than absorb some sugar and
prevent 'dumping'). This means that no matter how much
calcium supplements you take, research has shown that
your body might not be able to access it. And this means,
you have a strong probability of
coming down with osteoporosis sometime after the sixth
year post op.
The newest studies show that gastric bypass patients lack a hormone
called "Ghrelin" in their bloodstream. This hormone is known
to encourage the production of "human growth hormone". The lack of
this hormone (and consequently no HGH) in gastric bypass patients may
explain the fact that most seem to age greatly after their gastric
bypass. HGH is considered the key factor in our aging process - the less we
have, the more we age.
You will have to
supplement other vitamins like B12 and iron for the rest
of your life. B12 is best taken in 'shots'. This is
because your digestive system no longer digests or
absorbs many vitamins and nutriants.
You might have to go back to the
hospital for repeat surgeries for hernias, bowel
obstruction (this is
very painful until you have the surgery done) and scopes
(tubes down your throat to see if all if ok). Some WLS
post ops also have a lot of plastic surgery because the
original surgery does not give them the svelte figure
they imagined it would.
Gastric bypass patients don't have much appetite because it is
difficult to eat and they often are nauscious. Think of eating food when the opening for
the food to leave the pouch is very very small.
Everything has to be chewed very well. Because if it gets
stuck in the opening leading to the small gut, it can
cause very intense pain until it dissolves. Occasionally
patients have to go to the hospital to get the food
removed surgically.
Bad gut bugs: After your stomach is made very small, it
will not produce much acid anymore. This is done to save
acid from burning your esophagus but the down side is
that the bacteria in the food do not get killed and can
get into the blood stream. This is called "leaky
gut" and is suspected to cause autoimmune disorders
like LUPUS, rheumatoid arthritis and even in rare cases,
multiple sclerosis. Since you may have a lot of bacteria
getting into your blood, you might be sick more often
after weight loss surgery.
Restrictive diet and exercise: Some people go into surgery because they
think the procedure will work automatically. The reality
is that after the first year, gastric bypass patients
will likely face dieting and exercise to maintain their
new physique. The restrictive diet includes no fat, no
sugar - much more restrictive than is necessary without
surgery! (The "Hebrew Study" showed
that 25 % of those patients surveyed, gained back all
their weight within 6 years. Only 7 % of those surveyed
kept off ALL the weight that they lost)
Some post ops who are four and five
years out from surgery, do stay fairly thin but only because they have a lot
of physical problems. Be careful that you aren't exchanging one set of
problems for another. Cancer will make you thin also but that doesn't mean
it's something a person would want to have.
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 nutriants) has been observed
to cause depression.
The reason you start
to gain weight after a year or so, is because your body
has set your metabolism way down due to the prolonged
starvation for 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 brain is not necessary
to maintain life. (Some surgeons suggest doing
tests to make sure your body is burning muscle and organ
parts - instead of fat - so that you get the proper
amount of protein in those months after surgery when you
are not eating very much...-
see the Scopinaro study on www.duodenalswitch.com
)
According to what statistics are
known (although the gastric bypass has been being done
for over 40 years, not many long term post ops are to be
found), about 1 out of every 200 who has the surgery,
dies from complications. There is also some evidence that
many deaths during the first year after surgery may be
attributed to other causes like 'obesity'. This would
possibly make the statistics incorrect i.e. the death
rate might be and probably is, much higher than those
selling the surgery are willing to admit.
Success stories on websites are usually newly post op. All diets
have their group of 'camp followers' who are successful
with the diet and say its great. Weight Loss surgery
(which IS a diet) is no different. But most of the camp
followers are less than three years out from surgery.
Some rheumatogists
seem to feel that the high prevailence of rheumatoid
arthritis, joint disease and the like they see in post op
WLS patients IS connected to the surgery. A rare
complication also seen a few years after surgery is a
partial paralysis, usually of the legs called
"neuropathy". B12 deficiency can cause autoimmune
disease like LUPUS.
Reversing the procedure:
Today's
surgeries are meant to be permanent. This is because in
most of them, the stomach is partially destroyed. This is
why surgeons talk about a "take down" rather
than a reversal. A person requiring a takedown usually
has a difficult time finding a surgeon to DO one. A
person should realize that once they have had the
surgery, even with a 'takedown' they will have
repercussions for the rest of their lives.
Is Surgery the only way? Will you
die without it?
Numerous studies of obese people show that if they
exercise and eat a reasonably healthy diet, they can
remain large and still be healthy. Programs like
"Susan Powter" allow for unlimited quantities
of many foods and will take anyone's size down to within
the so called "average range".
If you have a proximal
gastric bypass, you will probably begin gaining weight
after 12 to 18 months. For this reason, some patients
have distal bypasses and BPD (bileopancreatic
diversions). In this type of bypass, over 50
percent of the small intestine is bypassed, not that much
different from the old (and dangerous) intestinal bypass!
If you have this drastic surgery, there is a good chance
that you might develop severe nutritional deficiencies
due to lack of absorption. Many surgeons will not do
distal bypasses and BPDs for this reason. Although
they've refined the operation somewhat by closing off the
bypassed intestine, there are no guarantees of not having
the nasty side effects seen in the older surgeries.
Liver failure: patients are told that the old 'intestinal
bypass' is no longer done due to the high incidence of
liver failure in patients. However, many post op gastric
bypass patients have elevated liver enzymes, a sign of
liver damage. There are no guarantees that the gastric
bypass won't also cause liver failure long term.
Stomach Cancer: According to medical books, anyone whose
stomach is cut open, cut in two or surgically modified
(called a 'gastrectomy') is of much higher risk for
stomach cancer.
According to the ASBS website: "Any
procedure involving malabsorption must be considered at
risk to develop at least some of the malabsorptive
complications exemplified by JIB (jejuno-ileal bypass). " All gastric
bypasses work partially through malabsorption so the
following complications might (according to the ASBS) be
seen with the modern gastric bypass:
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.
It should be noted that all
surgeries are not equal. A new surgery, the Adjustable Band,
has just been approved by the FDA. This is the most often
done weight loss surgery in Europe. Although there are not
statistics on long term repercussions, this surgery, unlike
the others IS reversible as the stomach is not destroyed in
any way. The band is not complication free by any means and
there is some evidence that it's rather uncomfortable to live
with at times, however, the success rates with the adjustable
band are similar to those seen with the gastric bypass.
As
with all things, if in doubt, don't. You can
always have the surgery at a later date when you have a
greater comfort level about it.
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