Posts categorized "Weight Loss Surgery" Feed

Food intolerances two years after gastric bypass (PS - No, really?)

Apparently this concern with gastric bypass patients hasn't been "well-studied."

Hey researchers - PLEASE SEEK OUT PATIENTS WHOM COMPLAIN OF EXACTLY THESE ISSUES FROM DAY ONE.  

Because, uh, *putting on my Dr. Google Hat* they're totally normal and expected, or so we thought?  Or am I living under a rock where it's that we're not supposed to live with digestive distress most of the time?I suppose this is my bias because I live as a distressed patient, with a distressed patient, and know mostly only distressed patients?  And WHAT IS GOING ON WITH THE FOODS LISTED IN THIS STUDY!?

I am using a lot of question marks lately.  I need to stop that.

Discuss.

Study blurb via Reuters -

(Reuters Health) - A common weight loss surgery is associated with long-term gastrointestinal problems and food intolerance, a recent study suggests.

Researchers examined data on 249 extremely obese patients who had what’s known as laparoscopic Roux-en-Y gastric bypass, which reduces the stomach to a small pouch about the size of an egg.

Two years after surgery, these patients had lost about 31 percent of their total body weight on average. But compared to the control group of 295 obese people who didn’t have operations, the gastric bypass patients were far more likely to experience indigestion and an inability to tolerate multiple foods.

“It was already known from previous studies that the Roux-en-Y gastric bypass might aggravate gastrointestinal symptoms after surgery,” said lead study author Dr. Thomas Boerlage of MC Slotervaart in Amsterdam.

 

 


Worth a read. New York Times article about a year in the life of bariatric surgery

Worth a read, and worth a watch.  This mimics a bit of my experience, my family's experiences, and brings up some (deeper) questions.  As someone who's had gastric bypass in 2004, I'm always intrigued at any new science that's discovered about the gut - brain connections.

"Nearly 200,000 Americans have bariatric surgery each year. Yet far more — an estimated 24 million — are heavy enough to qualify for the operation, and many of them are struggling with whether to have such a radical treatment, the only one that leads to profound and lasting weight loss for virtually everyone who has it. Most people believe that the operation simply forces people to eat less by making their stomachs smaller, but scientists have discovered that it actually causes profound changes in patients’ physiology, altering the activity of thousands of genes in the human body as well as the complex hormonal signaling from the gut to the brain."

Article - New York Times


A very powerful self-photography project of weight loss surgery.

Finally.  Something I can post.

©geballe-sitting

"Currently, Samantha's work focuses on conceptual portraiture, allowing her to explore human emotion from the inside out. She is working on an on-going self-portrait series focused on body image and healing that challenges viewers to question what is means to accept oneself. "

©geballe-stomach

 

Her photos are shocking if not absolutely realistic and raw if you have lost hundred(s) of pounds with weight loss surgery

If you have yet to do so, I would not be alarmed.  Question the photos.  Dig into them.  Feel it.  This is is what we know.

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Cropped image. 


Before You Spend $26,000 on Weight-Loss Surgery, Do This - What?

Agreed.

It was the first thing we all did BEFORE weight loss surgery 13 - 15 years ago ANYWAY. Because, it works.

The problem *is* the flipping ________ is addictive and NOBODY GETS THAT PART OF THE EQUATION, and until THAT is figured out?

THE ANSWER IS WEIGHT LOSS SURGERY.

New York Times Op -

Before You Spend $26,000 on Weight-Loss Surgery, Do This

Download Before You Spend $26,000 on Weight-Loss Surgery, Do This - The New York Times

Earlier this year, the Food and Drug Administration approved a new weight-loss procedure in which a thin tube, implanted in the stomach, ejects food from the body before all the calories can be absorbed.

Some have called it “medically sanctioned bulimia,” and it is the latest in a desperate search for new ways to stem the rising tides of obesity and Type 2 diabetes. Roughly one-third of adult Americans are now obese; two-thirds are overweight; and diabetes afflicts some 29 million. Another 86 million Americans have a condition called pre-diabetes. None of the proposed solutions have made a dent in these epidemics.

Recently, 45 international medical and scientific societies, including the American Diabetes Association, called for bariatric surgery to become a standard option for diabetes treatment. The procedure, until now seen as a last resort, involves stapling, binding or removing part of the stomach to help people shed weight. It costs $11,500 to $26,000, which many insurance plans won’t pay and which doesn’t include the costs of office visits for maintenance or postoperative complications. And up to 17 percent of patients will have complications, which can include nutrient deficiencies, infections and intestinal blockages.

It is nonsensical that we’re expected to prescribe these techniques to our patients while the medical guidelines don’t include another better, safer and far cheaper method: a diet low in carbohydrates.

Once a fad diet, the safety and efficacy of the low-carb diet have now been verified in more than 40 clinical trials on thousands of subjects. Given that the government projects that one in three Americans (and one in two of those of Hispanic origin) will be given a diagnosis of diabetes by 2050, it’s time to give this diet a closer look.

When someone has diabetes, he can no longer produce sufficient insulin to process glucose (sugar) in the blood. To lower glucose levels, diabetics need to increase insulin, either by taking medication that increases their own endogenous production or by injecting insulin directly. A patient with diabetes can be on four or five different medications to control blood glucose, with an annual price tag of thousands of dollars.

Yet there’s another, more effective way to lower glucose levels: Eat less of it.

Glucose is the breakdown product of carbohydrates, which are found principally in wheat, rice, corn, potatoes, fruit and sugars. Restricting these foods keeps blood glucose low. Moreover, replacing those carbohydrates with healthy protein and fats, the most naturally satiating of foods, often eliminates hunger. People can lose weight without starving themselves, or even counting calories.

Most doctors — and the diabetes associations — portray diabetes as an incurable disease, presaging a steady decline that may include kidney failure, amputations and blindness, as well as life-threatening heart attacks and stroke. Yet the literature on low-carbohydrate intervention for diabetes tells another story. For instance, a two-week study of 10 obese patients with Type 2 diabetes found that their glucose levels normalized and insulin sensitivity was improved by 75 percent after they went on a low-carb diet.

At our obesity clinics, we’ve seen hundreds of patients who, after cutting down on carbohydrates, lose weight and get off their medications. One patient in his 50s was a brick worker so impaired by diabetes that he had retired from his job. He came to see one of us last winter, 100 pounds overweight and panicking. He’d been taking insulin prescribed by a doctor who said he would need to take it for the rest of his life. Yet even with insurance coverage, his drugs cost hundreds of dollars a month, which he knew he couldn’t afford, any more than he could bariatric surgery.

Instead, we advised him to stop eating most of his meals out of boxes packed with processed flour and grains, replacing them with meat, eggs, nuts and even butter. Within five months, his blood-sugar levels had normalized, and he was back to working part-time. Today, he no longer needs to take insulin.

Another patient, in her 60s, had been suffering from Type 2 diabetes for 12 years. She lost 35 pounds in a year on a low-carb diet, and was able to stop taking her three medications, which included more than 100 units of insulin daily.

One small trial found that 44 percent of low-carb dieters were able to stop taking one or more diabetes medications after only a few months, compared with 11 percent of a control group following a moderate-carb, lower-fat, calorie-restricted diet. A similarly small trial reported those numbers as 31 percent versus 0 percent. And in these as well as another, larger, trial, hemoglobin A1C, which is the primary marker for a diabetes diagnosis, improved significantly more on the low-carb diet than on a low-fat or low-calorie diet. Of course, the results are dependent on patients’ ability to adhere to low-carb diets, which is why some studies have shown that the positive effects weaken over time.

A low-carbohydrate diet was in fact standard treatment for diabetes throughout most of the 20th century, when the condition was recognized as one in which “the normal utilization of carbohydrate is impaired,” according to a 1923 medical text. When pharmaceutical insulin became available in 1922, the advice changed, allowing moderate amounts of carbohydrates in the diet.

Yet in the late 1970s, several organizations, including the Department of Agriculture and the diabetes association, began recommending a high-carb, low-fat diet, in line with the then growing (yet now refuted) concern that dietary fat causes coronary artery disease. That advice has continued for people with diabetes despite more than a dozen peer-reviewed clinical trials over the past 15 years showing that a diet low in carbohydrates is more effective than one low in fat for reducing both blood sugar and most cardiovascular risk factors.

The diabetes association has yet to acknowledge this sizable body of scientific evidence. Its current guidelines find “no conclusive evidence” to recommend a specific carbohydrate limit. The organization even tells people with diabetes to maintain carbohydrate consumption, so that patients on insulin don’t see their blood sugar fall too low. That condition, known as hypoglycemia, is indeed dangerous, yet it can better be avoided by restricting carbs and eliminating the need for excess insulin in the first place. Encouraging patients with diabetes to eat a high-carb diet is effectively a prescription for ensuring a lifelong dependence on medication.

At the annual diabetes association convention in New Orleans this summer, there wasn’t a single prominent reference to low-carb treatment among the hundreds of lectures and posters publicizing cutting-edge research. Instead, we saw scores of presentations on expensive medications for blood sugar, obesity and liver problems, as well as new medical procedures, including that stomach-draining system, temptingly named AspireAssist, and another involving “mucosal resurfacing” of the digestive tract by burning the inside of the duodenum with a hot balloon.

We owe our patients with diabetes more than a lifetime of insulin injections and risky surgical procedures. To combat diabetes and spare a great deal of suffering, as well as the $322 billion in diabetes-related costs incurred by the nation each year, doctors should follow a version of that timeworn advice against doing unnecessary harm — and counsel their patients to first, do low carbs.

Sarah Hallberg is medical director of the weight loss program at Indiana University Health Arnett, adjunct professor at the school of medicine, director of the Nutrition Coalition and medical director of a start-up developing nutrition-based medical interventions. Osama Hamdy is the medical director of the obesity and inpatient diabetes programs at the Joslin Diabetes Center at Harvard Medical School. A version of this op-ed appears in print on September 11, 2016, on page SR1 of the New York edition with the headline: The Old-Fashioned Way to Treat Diabetes.


Study - Weight-Loss Surgery Linked To Increased Suicide Risk

Another OBVIOUS. 

Reuters -

“These findings suggest that more effort may be needed to improve access to mental health care services in these patients should they need them, and perhaps some screening in the second year and onwards,” Bhatti said. 

During the first three years after surgery, 111 patients received emergency care for self-inflicted injuries, or roughly 1 percent of people in the study. While small, the risk of these emergencies was 54 percent higher after surgery than it was before.

Study - JAMA

Importance  Self-harm behaviors, including suicidal ideation and past suicide attempts, are frequent in bariatric surgery candidates. It is unclear, however, whether these behaviors are mitigated or aggravated by surgery.

Objective  To compare the risk of self-harm behaviors before and after bariatric surgery.

Design, Setting, and Participants  In this population-based, self-matched, longitudinal cohort analysis, we studied 8815 adults from Ontario, Canada, who underwent bariatric surgery between April 1, 2006, and March 31, 2011. Follow-up for each patient was 3 years prior to surgery and 3 years after surgery.

Main Outcomes and Measures  Self-harm emergencies 3 years before and after surgery.

Results  The cohort included 8815 patients of whom 7176 (81.4%) were women, 7063 (80.1%) were 35 years or older, and 8681 (98.5%) were treated with gastric bypass. A total of 111 patients had 158 self-harm emergencies during follow-up. Overall, self-harm emergencies significantly increased after surgery (3.63 per 1000 patient-years) compared with before surgery (2.33 per 1000 patient-years), equaling a rate ratio (RR) of 1.54 (95% CI, 1.03-2.30; P = .007). Self-harm emergencies after surgery were higher than before surgery among patients older than 35 years (RR, 1.76; 95% CI, 1.05-2.94; P = .03), those with a low-income status (RR, 2.09; 95% CI, 1.20-3.65; P = .01), and those living in rural areas (RR, 6.49; 95% CI, 1.42-29.63; P= .02). The most common self-harm mechanism was an intentional overdose (115 [72.8%]). A total of 147 events (93.0%) occurred in patients diagnosed as having a mental health disorder during the 5 years before the surgery.

Conclusions and Relevance  In this study, the risk of self-harm emergencies increased after bariatric surgery, underscoring the need for screening for suicide risk during follow-up.

Link - http://archsurg.jamanetwork.com/article.aspx?articleid=2448916


Gastric bypass surgery lowers women's alcohol tolerance

Download 2015-08-gastric-bypass-surgery-lowers-women

A small study indicates that changes in how  is metabolized after surgery can speed its delivery into the bloodstream, resulting in earlier and higher peaks in blood-alcohol levels. Studying  who had undergone surgery, the researchers found that those who had consumed the equivalent of two drinks in a short period of time had blood-alcohol contents similar to women who had consumed four drinks but had not had the operation.

The research is published Aug. 5 in the journal JAMA Surgery.

"The findings tell us we need to warn patients who have  that they will experience changes in the way their bodies metabolize alcohol," said first author M. Yanina Pepino, PhD, an assistant professor of medicine in the Division of Geriatrics and Nutritional Science. "Consuming alcohol after surgery could put patients at risk for potentially serious problems, even if they consume only moderate amounts of alcohol."

Although this study included only women, it is likely that men who have gastric bypass surgery experience similar changes in how their bodies metabolize alcohol.

The researchers studied alcohol's effects in 17 obese women. Eight of the women had undergone Roux-en-Y gastric bypass surgery—the most common bariatric surgical procedure worldwide—one to five years before the study began. The other nine participants had not yet had the operation.

As part of the study, the women spent two days, about one week apart, at Washington University's Clinical Research Center. On one visit, each woman randomly consumed either the equivalent of two  or two nonalcoholic beverages during a 10-minute period. At the second visit, each was given the beverages not received during the first visit. At both visits, the researchers measured the women's blood-alcohol contents and used a survey to assess their feelings of drunkenness.

The women in the gastric bypass group had an average body mass index (BMI) of 30, which is considered obese, but it compared with an average BMI of 44 for the women who had not yet had the surgery. Among those who had not undergone surgery, blood-alcohol content peaked about 25 minutes after they finished consuming the alcohol and measured 0.60. In women who had the surgery, blood-alcohol content peaked at 5 minutes after drinking and reached 1.10, significantly above the legal driving limit of 0.80.

"These findings have important public safety and clinical implications," said senior investigator Samuel Klein, MD, the William H. Danforth Professor of Medicine and director of the Center for Human Nutrition. "After just two drinks, the blood-alcohol content in the surgery group exceeded the legal driving limit for 30 minutes, but the levels in the other group never reached the legal limit.

"The peak blood-alcohol content in the surgery group also met the criteria that the National Institute on Alcohol Abuse and Alcoholism uses to define an episode of binge drinking, which is a risk factor for developing alcohol problems."

Women who had undergone gastric bypass also reported feeling the effects of alcohol earlier and for longer periods of time than women who had not had the surgery.

The study is not the first to find that gastric  can alter alcohol metabolism, but Pepino said it is significant because earlier studies had measured blood alcohol less vigorously and were less clear about the extent of the changes in alcohol metabolism.

"The women who had the surgery only received the equivalent of two drinks, but it was as if they had consumed twice that amount," she said. "Consuming alcohol after surgery the way one did before the operation could put patients at risk for potentially serious consequences, even when they drink only moderate amounts of alcohol."

More information: Pepino MY, Okunade AL, Eagon JC, Bartholow BD, Bucholz K, Klein S. Effect of Roux-ex-Y gastric bypass surgery: converting 2 alcoholic drinks to 4. JAMA Surgery, published online Aug. 5, 2015. DOI: 10.1001/jamasurg.2015.1884 


Long-term followup of type of bariatric surgery finds regain of weight, decrease in diabetes remission

While undergoing laparoscopic sleeve gastrectomy induced weight loss and improvements in obesity-related disorders, long-term followup shows significant weight regain and a decrease in remission rates of diabetes and, to a lesser extent, other obesity-related disorders over time, according to a study published online by JAMA Surgery.

Obesity was recognized as a global epidemic by the World Health Organization 15 years ago and rates of obesity have since been increasing. Obesity is currently considered a severe health hazard and a risk factor for mellitus, hypertension, abnormal lipid levels, heart failure, and other related disorders. Bariatric procedures are reportedly the most effective strategy to induce weight loss compared with nonsurgical interventions. Laparoscopic sleeve gastrectomy (LSG) is a common and efficient bariatric procedure with increasing popularity in the Western world during the last few years, but data on its long-term effect on obesity-related disorders are scarce, according to background information in the article.

Andrei Keidar, M.D., of Beilinson Hospital, Petah Tikva, Israel, and colleagues collected data on all patients undergoing LSGs performed by the same team at a university hospital between April 2006 and February 2013, including demographic details, weight followup, blood test results, and information on medications and comorbidities.

A total of 443 LSGs were performed. Complete data were available for 54 percent of patients at the 1-year follow-up, for 49 percent of patients at the 3-year follow-up, and for 70 percent of patients at the 5-year follow-up. The percentage of excess  was 77 percent, 70 percent, and 56 percent, at years 1, 3 and 5, respectively; complete remission of diabetes was maintained in 51 percent, 38 percent, and 20 percent, respectively, and remission of hypertension was maintained in 46 percent, 48 percent, and 46 percent, respectively.

The decrease of  level was significant only at years 1 and 3. The changes in total cholesterol level (preoperatively and at 1, 3, and 5 years) did not reach statistical significance.

"The longer follow-up data revealed weight regain and a decrease in remission rates for type 2 and other obesity-related comorbidities. These data should be taken into consideration in the decision-making process for the most appropriate operation for a given obese patient," the authors write.

More information: JAMA Surgery. Published online August 5, 2015. DOI: 10.1001/jamasurg.2015.2202 


Year Eleven, Plot Twist.

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Oddly enough last year was my best in terms of weight loss and weight maintenance after my roux en y gastric bypass now eleven years ago.

I just searched the blog for my yearly *cringe* "surgiversary" updates and it appears it really was.

 "Best."  I maintained a nearly-normal bodyweight for half of the year, guys.  If I look back on my averages over the last ten years, the weight is smack-dab in the middle of average.  I am just that.  

Super-average.  

I started out the year at my near lowest, while using the gym and eating decently.  My goal had been to continue that - and ignore weight if I could add muscle tone.  

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One of the most common questions I get inboxed to me is:  What Do You Eat Everyday - What Do You Do?!  Here is the thing:  PEOPLE VARY DRASTICALLY.  I realized that my intake vs. output is a delicate balance.

Here's my intake for the most part of the last 90 days:

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This looks mostly like this, with days of "Want pizza for dinner?  Who wants mozzarella sticks?"  Once a week.  I eat very little meat, though I am still cooking it a couple times a week for the family.

Breakfast - 

  • Coffee - unsweetened almond milk - cocoa powder
  • Frozen tofu based meal, other

Lunch -

  • Leftovers from dinner or
  • Soup or salad or
  • Bread + cheese

Snack - 

  • Chickpeas, whole grain crackers, cheese, veggie burrito

Dinner - 

  • Protein, veggie, carb - whatever is made for the family or...
  • Frozen vegan meal

Snack -

  • More dinner, usually, I honestly don't eat at dinner time... I eat before bed.  I might have a few bites at dinner time, especially if I am cooking, and then I don't want anything.  

This isn't much different than my eating of the year before - and I maintain my weight at this level of calories.  I would assume I eat about 1500 - 1700 most days with days lower, and days higher (rare).  

I actually lose weight at this intake if I am moving enough.  

Disclaimer, BMI SUCKS and I have NEVER been in the normal category for more than two minutes because I am SHORT AND I AM SHRINKING so if I want to EAT, I HAVE TO MOVE MY ASS.

I was.  I'm not.   No excuses.  

My intentions were good, but life always seems to have different plans.  

I developed some super fun back pain that coincided with less time at the gym (...yes I think movement HELPS pain, but getting past pain to MOVE is now the problem!) and was diagnosed with some degenerative disc disease.  My time working out was cut drastically with my spouse's work schedule changing - kid's school schedules and just having no means to go.  Adding the lack of gym time to pain = Beth not moving her ass because it hurts = Beth not moving.  I started slugging out at home from August (...when the schedule changed) to this winter.  I hate to whine because Everybody Huuuurttttts.   I'm also super realistic and I know I'm getting older, and it is unlikely that my back will Get Better at this age.  It isn't going to benefit me to complain about it now because it's going to get worse with time.  

Grinding along through back pain is difficult though, when it makes every part of your day a little more complicated - you'd think just sitting would be restful - easy.   Sitting here is the most painful part of my day aside from attempting to sleep laying down, I live in a series of twitchy z-z-z-zaps.  If I could pace all day long, I'd be fine.  

And I just may start doing that.

Why?  *changing tenses, writing badly but writing*

There was a single motivation -- I got on the scale after knowing that I was not fitting in my size medium running pants.   THEY SQUISHED ME LIKE A SAUSAGE.  I knew I had gained weight, I could see it - but - I kept squishing into them.  So what if my legs are more puffy?  Whatever.  

And then my boobs.  MY BOOBS.  I didn't HAVE ANY, and a few weeks ago I'm all - O - O - and WHY DO THEY HURT I'd better start my cycle RIGHT NOW or I am going to cry and I just might cry right now or throw up.

Oh.  

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I'll save you the dramatic implosion that occurred after three of those, but I've been to the MD twice, and I see a maternal-fetal medicine doctor tomorrow.    I was not planning this, obviously, nor was I telling anyone, but a certain spouse outed me - and a lot of people took it as a joke.  

I don't find it funny.

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I've got this.  I have never had a pregnancy WHILE on anti-epileptic medications, so that is of course of concern as I CANNOT be unmedicated and live safely.  If you recall, my seizure activity became evident during my first post-RNY pregnancy and it was undiagnosed for a very long time.   Also, apparently, I AM OLD.  I am "Of Advanced Maternal Age."  

ADVANCED.  AGE.   3-5.  This was the year, that I told my husband, I think we are old enough to have kids now.  Forget that my oldest is the same age as I was when I got pregnant with her.  

She said, "Well, at least it isn't me."  Yes, thanks for that.

Grandma MM doesn't really have a ring to it.  And I think my mother would explode. 

 


Bariatric surgery may improve pregnancy outcomes - mostly

Many women opt for bariatric surgery in order to increase chances of maintaining a healthy pregnancy.  A recent study suggests that weight loss surgery can help a woman do just that, but there are risks.

Personally, my full term post bariatric surgery pregnancy was different than my pre-WLS pregnancies.  I was at a more normal bodyweight at the time of my daughter's gestation, and I did not seem to suffer the ill effects of obesity on pregnancy like I had with my prior children.  I had no high blood pressure, no high blood sugar, nor did I land on bedrest - which I had with previous babies.    My post RNY pregnancy offered me anemia and rampant hypoglycemia.  I was not well. 

She was born healthy, but small, in comparison to my earlier babies.  I noted a lack of body fat at birth.  This is several weeks old.

Baby
My post bariatric surgery baby - my smallest birthweight baby.

 

New York Times

While the study found some risks for women who had surgery, including more babies born too small and a greater likelihood of stillbirths, experts said that overall the results were better.

The findings have implications for an increasing number of women and children, especially in the United States, where nearly a third of women who become pregnant are obese. Obese women have more problems in pregnancy, including gestational diabetes, pre-eclampsia, and stillbirth. Their babies are more likely to be premature, overweight or underweight at birth, have certain birth defects, and develop childhood obesity.

The study, published Wednesday in The New England Journal of Medicine, sought to find out if surgery could safely mitigate some of those effects. Swedish researchers, led by Kari Johansson, a nutritionist at the Karolinska Institute, evaluated records of 2,832 obese women who gave birth between 2006 and 2011, comparing women who had bariatric surgery before becoming pregnant with women who did not.

They found that women who had had surgery were about 30 percent as likely to develop gestational diabetes, which can lead to pre-eclampsia, low blood sugar, birth defects and miscarriage. They were about 40 percent as likely to have overly large babies, whose challenges can include lung and blood problems.

The outcomes were worse in some categories. Women who had surgery were twice as likely to have babies who were small for their gestational age, suggesting the need for better nutrition for pregnant women with surgically-reduced stomachs. And more of their babies were stillborn or died within a month after birth, although the number of such deaths in each group was very small and might have been due to chance, experts and the authors said. There was no significant difference in rates of premature births or babies with birth defects.

The study via NEJM -

BACKGROUND

Maternal obesity is associated with increased risks of gestational diabetes, large-for-gestational-age infants, preterm birth, congenital malformations, and stillbirth. The risks of these outcomes among women who have undergone bariatric surgery are unclear.

METHODS

We identified 627,693 singleton pregnancies in the Swedish Medical Birth Register from 2006 through 2011, of which 670 occurred in women who had previously undergone bariatric surgery and for whom presurgery weight was documented. For each pregnancy after bariatric surgery, up to five control pregnancies were matched for the mother’s presurgery body-mass index (BMI; we used early-pregnancy BMI in the controls), age, parity, smoking history, educational level, and delivery year. We assessed the risks of gestational diabetes, large-for-gestational-age and small-for-gestational-age infants, preterm birth, stillbirth, neonatal death, and major congenital malformations.

RESULTS

Pregnancies after bariatric surgery, as compared with matched control pregnancies, were associated with lower risks of gestational diabetes (1.9% vs. 6.8%; odds ratio, 0.25; 95% confidence interval [CI], 0.13 to 0.47; P<0.001) and large-for-gestational-age infants (8.6% vs. 22.4%; odds ratio, 0.33; 95% CI, 0.24 to 0.44; P<0.001). In contrast, they were associated with a higher risk of small-for-gestational-age infants (15.6% vs. 7.6%; odds ratio, 2.20; 95% CI, 1.64 to 2.95; P<0.001) and shorter gestation (273.0 vs. 277.5 days; mean difference −4.5 days; 95% CI, −2.9 to −6.0; P<0.001), although the risk of preterm birth was not significantly different (10.0% vs. 7.5%; odds ratio, 1.28; 95% CI, 0.92 to 1.78; P=0.15). The risk of stillbirth or neonatal death was 1.7% versus 0.7% (odds ratio, 2.39; 95% CI, 0.98 to 5.85; P=0.06). There was no significant between-group difference in the frequency of congenital malformations.

CONCLUSIONS

Bariatric surgery was associated with reduced risks of gestational diabetes and excessive fetal growth, shorter gestation, an increased risk of small-for-gestational-age infants, and possibly increased mortality. (Funded by the Swedish Research Council and others.)

PS.  Post RNY baby is eight years and four months old now.  She's fine.

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Exercise improves insulin sensitivity after gastric bypass

Clinical trial demonstrates additive effect of exercise following gastric bypass.   

So. do. it.  I know, I know, easier said than done. 

Over 75 million adults in the US are obese. These individuals are predisposed to health complications, including diabetes, heart disease, and cancer. Gastric bypass surgery results in dramatic weight loss and can improve diabetes symptoms in obese patients. A new study in the Journal of Clinical Investigation reveals that exercise following bypass surgery provides additional benefit for obese patients. Bret Goodpaster and colleagues at the University of Pittsburgh conducted a study on individuals that had recently undergone gastric bypass surgery. One group followed a moderate exercise protocol for 6 months, while the control group underwent a health education program. Individuals in both groups exhibited dramatic weight loss and reduced fat mass. However, individuals in the exercise group had improved insulin sensitivity and cardiovascular fitness. The results of this study support the inclusion of an exercise program following gastric bypass surgery.

Read the article released earlier this week in JCI: http://buff.ly/1wlKroB


A dirty not-so-secret of the gastric bypass world has been studied! AND WE WERE RIGHT.

carbonation bubbles
Via Mira Shemeikka - Flickr

What does a gastric bypass patient do when they feel food stuck - trapped - balled up - in their gastric pouch or stomach, or even further down in the intestine?

Sometimes we walk it out, sometimes change positions rapidly hoping the food shifts, oftentimes we lay on a certain side and get all fetal-curled and try to work the food down... we do countless things to relieve the pressure of a stucked.

BE_Stage13_f01

However, many times it is just easier to break up a stuck, and many of us know this because we have been doing it for years intuitively because STUCKS!! HURT!!

Before you ask -- "What Does A Stuck Feel Like?"  You'll know it when it happens.  You will also know it if it has happened to you.

You may have another word to describe it -- too.  I often describe it as oncoming death.  I may or may not have sent myself to the ER once with a stuck because it felt like a heart attack, panic attack because the squeezing in my chest made me anxious -- bad combination.   Too much of the wrong, sticky, fibrous food, trapped in the gut PLUS anxiety over the malcontent = OMG I AM DYING.   I am dying right now.  Am I really?  OMG. 

I know better now.  I avoid it.  

DISCLAIMER -- THIS POST IS NOT INTENDED NOR CONSTRUED AS MEDICAL ADVICE.  I AM A 10.6 year post GASTRIC BYPASS PATIENT WITH ZERO PROFESSIONAL CREDS.  DO NOT LISTEN TO ME.  This is JUST my personal experience, mmmkay? YES I AM YELLING CAUSE Y'ALL DO NOT LISTEN.

Some of us whom grew up as baby bariatric patients not following our rules -- learned something early on.

Carbonated liquids fix stucks, because it forces the food through.  This relieves the pain, and clears the gut.  You might notice something about those of us willing to tell the truth about our (bad) habits.  We tend to drink a LOT of Diet Coke, Diet Pepsi, and have for years since our weight-loss surgeries, some of us more than we did before WLS.  

"Diet Coke and Coke Zero worked just as well as the sugared versions because they contain the same basic ingredients."

BECAUSE IT FEELS GOOD.

Bubbles fix the stucks.  

Stucks are technically called bezoars or phytobezoars which means FOOD BALL - a gastric concretion formed of vegetable fibers, with the seeds and skins of fruits, and sometimes starch granules and fat globules.  It's basically a GREASE TRAP of things that we might not have been able to digest due to our WLS arrangement - and the diet soda goes down and acts as Liquid Plumbr.

Screen Shot 2014-10-15 at 9.00.49 AM

 

Hey, it's not my study, but it is my pre-treatment -- and has been for at least ten years - 

Not exactly THIS way - but - y'know -

 

Apt12141-fig-0002

http://onlinelibrary.wiley.com/doi/10.1111/apt.12141/full

Medscape - 

Drinking Coca-Cola appears to be an effective treatment for gastric phytobezoar in 50% of cases, and combining the soda with additional endoscopic methods may lead to resolution of as many as 91.3% of phytobezoars, according to a newly published review.

Spiros D. Ladas, MD, from the Gastroenterology Division, First Department of Medicine–Propaedeutic, Medical School, Athens University, Laikon Hospital, Greece, and colleagues presented the results of their systematic literature review in an article published online December 17, 2012, and in the January 2013 issue ofAlimentary Pharmacology and Therapeutics.

The authors searched the literature for the combined keywords "phytobezoars treatment" and "Coca-Cola lysis" and reviewed 24 articles published during a 10-year period between 2002 and 2012. The articles included 46 patients. The authors note that the majority of the articles included in the review did not have patient follow-up, and therefore the review cannot speak to patient relapse.

Although most of the articles were case reports, one was a retrospective study of 17 patients. In their review, Dr. Ladas and colleagues found that only 4 patients (8.7%) who received Coca-Cola treatment went on to develop small bowel obstruction that required surgical treatment. Despite the need for surgery, 3 of the 4 patients still had partial dissolution of their phytobezoars from the Coca-Cola treatment.

The researchers also report that the soda was able to completely dissolve gastric phytobezoars in half of the patients. Although they were unable to state the mechanism of action with certainty, they posit that the soda's pH of 2.6 played an important role in fiber digestion.

Diospyrobezoars (persimmon bezoars) are one of the more difficult types of bezoars to dissolve. They are formed after persimmon ingestion and are characterized by a hard consistency. The authors found that diospyrobezoars were less likely to be completely dissolved by the soda than were phytobezoars (60.6% vs 23%; P = .022).

Physicians seek conservative treatment options, such as dissolution therapies and endoscopic fragmentation techniques, for bezoars, to avoid surgery. The reviewers suggest that Coca-Cola ingestion should be the treatment of choice for gastric phytobezoars because it allows for reduced patient stay in the hospital and may not require endoscopies or equipment. "Moreover," they conclude, "availability, low cost, rapid way of action, simplicity in administration and safety renders Coca-Cola a cost-effective therapy for gastric phytobezoars."

Low-cost effective therapy for stucks.  Um, yeah?  Considering the alternative, I'll avoid the pain --

Slide22


The Biggest Loser Meltdown Moment

Did you watch this last night?

"I don't want you to go through what your dad has gone through." -Dr.

So -- you KNOW I am thinking it -- I probably yelled AT THE TV.

angry lego head

I would like to know what happened to Rob's dad after all this crying and freaking out with the shaming of the wheel-chair.  I hate when information about weight loss surgery is thrown out there to the general public like "this" without any context.

Biggest Loser, please explain.  I understand that the producers like to create 'breakthrough' moments with the contestants to get them motivated and moving forward and to tear off all excuses, but why create a stigma around weight loss surgery? 


Vertical Sleeve Gastrectomy — Considerations and Nutritional Implications

Note - I pasted most of this article in full from "Today's Dietician" as it is chock full of good nuggets of information and vitamin information - scroll down - I do not own this information the links are all below -  GOOD GOOD STUFF here!  -MM  

Thank you Bariatric Fusion for the tip!

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Vertical Sleeve Gastrectomy — Considerations and Nutritional Implications.  

All below.

Continue reading "Vertical Sleeve Gastrectomy — Considerations and Nutritional Implications" »


All Of Me - PBS Independent Lens

http://www.pbs.org/independentlens/all-of-me/


Bariatric surgery leads to lasting improvement in health, studies say - TOS/ASMBS

From studies presented at this year's Obesity Society - ASMBS meeting in Atlanta, new data on weight loss surgeries long-term efficacy.

Not too shabby.  

LA Times

Fifteen years after they have weight-loss surgery, almost a third of patients who had Type 2 diabetes at the time they were operated on remain free of the metabolic disorder, a new study says. And six years following such surgery, patients had shaved their probability of suffering a heart attack over the next 10 years by 40%, their stroke risk by 42%, and their likelihood of dying over the next five years by 18%, additional research has concluded.

The two studies, both presented Wednesday at the annual meeting of the American Society for Metabolic and Bariatric Surgery in Atlanta, offer the first indications of weight-loss surgery's longer-term health benefits for patients. While researchers have demonstrated dramatic improvements in many bariatric patients' metabolic function in the short term, the durability of those improvements has been unclear.

Research suggests that over several years, many bariatric patients regain some of the weight they lose in the first two years -- a fact that has raised doubts about the cost-effectiveness of the surgery, which can cost $20,000 to $25,000 for the initial procedure, plus a wide range of costs to treat complications after surgery.

The new studies' findings that patients' health prospects remain better for several more years may make weight-loss surgery a more appealing treatment for insurers to cover, and for obese patients with health concerns to seek out.

The study that followed 604 bariatric patients in Sweden for 15 years found that in the first two years after surgery, 72% achieved diabetes remission: They were able to cease taking medication for the metabolic condition. After 15 years, a little more than half of those had diabetes again. But 31% had remained in remission.

By contrast, only 16% of the comparison group -- similarly obese patients with diabetes who did not get surgery -- had seen their diabetes remit in the first two years. At 15 years out, diabetes remission was six times likelier in those who had surgery than in the those who did not.

In another study, researchers at the Cleveland Clinic in Ohio followed bariatric patients for an average of six years after surgery. They tallied those patients' likelihoods of developing a wide range of health outcomes at the time of surgery and six years later, and compared them. To do so, they used the Framingham risk calculator to estimate the before-and-after 10-year risks of heart disease, stroke, death, kidney disease and complications such as diabetic retinopathy and poor circulation.

(The Framingham risk calculator is derived from probabilities gleaned from following more than 10,000 subjects in Framingham, Mass., in the Framingham Heart Study, which started in 1948.)

In this study, the bariatric patients lost 60% of their excess weight and 61% saw their diabetes remit after surgery. Overall, their risk of having coronary heart disease, stroke or peripheral heart disease dropped by 27%.

Bariatric surgeon Dr. John Morton, a professor of medicine at Stanford University who was not involved in either study, suggested that the results of more modern bariatric surgical procedures may be superior. He added that reducing the stress of obesity on the body, even if some weight returns, may improve a patient's long-term health prospects.

"Carrying extra weight can carry forth year to year," said Morton, who is president-elect of the American Society for Metabolic and Bariatric Surgery. He likened long-term obesity to smoking cigarettes for years, suggesting that the number of years a person remains obese (or smokes) may interact with their degree of obesity (or how much they smoke) to influence his or her likelihood of developing health problems.

 


Diabetes Remission Post Bariatric Surgery - or - Diabetes Comes Back For Some After WLS.

Diabetes Remission Post Bariatric Surgery

Medscape -  

Researchers in Pennsylvania have developed a tool comprising 4 preoperative clinical variables that surgeons and patients can use to predict the likelihood of type 2 diabetes remission after Roux-en-Y gastric bypass surgery.

Christopher D. Still, DO, director of Geisinger Obesity Institute, Danville, Pennsylvania, and colleagues developed their algorithm, known as the DiaRem score, on the basis of a retrospective cohort study of 690 patients who underwent gastric bypass surgery. They verified the results in 2 additional cohorts; their findings were published online September 13 in the Lancet Diabetes and Endocrinology.

DiaRem scores range from 0 to 22, with low scores consistently predicting higher remission rates and high scores predicting lower remission rates.

"Bariatric surgery is a very effective tool not so much for weight loss but curing or resolving comorbid medical problems," Dr. Still told Medscape Medical News in a telephone interview. "The surgery is the best we have for long-term success, but it's not without potential risks and costs."

Continue reading "Diabetes Remission Post Bariatric Surgery - or - Diabetes Comes Back For Some After WLS. " »


RNY patients after gastric bypass surgery have lower brain-hedonic responses to food than after gastric banding

RNY patients lose more than gastric band patients, and this study hypothesizes that RNY patients "think" differently about food.

As a ten-year RNY patient - I scream - AYE!  FOR THE LOVE OF DOG DO NOT FEED ME ICE CREAM!

It's called DUMPING SYNDROME, our brains learn to connect certain foods to the reactions they might or will cause, which is a learned behavior, and our brains react, which can be SEEN on an MRI machine.  Twitch.  Twitch.  (And, no, many people never ever learn.)

Amazing.

Study -

Objectives Roux-en-Y gastric bypass (RYGB) has greater efficacy for weight loss in obese patients than gastric banding (BAND) surgery. We hypothesise that this may result from different effects on food hedonics via physiological changes secondary to distinct gut anatomy manipulations.

Design We used functional MRI, eating behaviour and hormonal phenotyping to compare body mass index (BMI)-matched unoperated controls and patients after RYGB and BAND surgery for obesity.

Results Obese patients after RYGB had lower brain-hedonic responses to food than patients after BAND surgery. RYGB patients had lower activation than BAND patients in brain reward systems, particularly to high-calorie foods, including the orbitofrontal cortex, amygdala, caudate nucleus, nucleus accumbens and hippocampus. This was associated with lower palatability and appeal of high-calorie foods and healthier eating behaviour, including less fat intake, in RYGB compared with BAND patients and/or BMI-matched unoperated controls. These differences were not explicable by differences in hunger or psychological traits between the surgical groups, but anorexigenic plasma gut hormones (GLP-1 and PYY), plasma bile acids and symptoms of dumping syndrome were increased in RYGB patients.

Conclusions The identification of these differences in food hedonic responses as a result of altered gut anatomy/physiology provides a novel explanation for the more favourable long-term weight loss seen after RYGB than after BAND surgery, highlighting the importance of the gut–brain axis in the control of reward-based eating behaviour.