Tuesday, April 01, 2014

Questionable studies on obesity and weight loss surgery abound

Yet another eye catching headline hit recently.  "Obesity primes the colon for cancer!", it triumphantly announced.

And what was this "landmark study" you might ask?  They fed mice lard and then tested, and only the ones which were fat, had the "markers" for cancer.  Huh?  Are people supposed to believe this would apply to humans? 

Although we might have our suspicions about some humans, I can safely say we are NOT mice and a mouse GI tract barely resembles a human GI tract, if at all, and also, the mice which got fat, didn't get cancer -they only "had the markers" for cancer which means they might or might not get cancer by the time their short lives are ended.

If that's not questionable enough, try the the following study - the headline on this was about how Weight Loss surgery "cures" diabetes.  This study was on humans however, among those who had had a gastric bypass (which forces starvation for the first couple of years - starvation will always bring blood sugar levels down), barely more than 1/3 of the patients saw a remission, even in the first three years after surgery.

I wouldn't call those results impressive, especially considering that gastric bypass is so invasive.  Among patients who had the sleeve gastrectomy, the popular "surgery du jour" which only reduces the stomach (to the size of a thumb and about twice as long as a thumb), only 25% experienced a remission of their diabetes in the first three years.  Keeping in mind that without a stomach, digestion of fats and proteins is basically, not happening and patients must for the rest of their lives, consume protein drinks which are expensive, not paid by insurance and not good tasting to avoid protein deficiency diseases which have not been seen since the 1800's... they should also take B12 shots at least once a week since a greatly reduced stomach likely no longer digests vitamin B12 which can cause many and varied problems.... this doesn't seem worth the expense and pain of surgery for the small number of remissions of diabetes early on.

In a buyer, seller's society, consumers must be careful of what they buy -to avoid the myths seen on TV etc - and sadly, for post ops who experience one of the many complications, there is little available to support them.

Definitely, "buyer beware!" or...
  If it's too good to be true, it probably isn't...

Thursday, March 20, 2014

The Demise of a Great Blog

One of the most honest blogs on WLS (this patient sustained a seizure disorder after her gastric bypass and found 150 other patients who had suffered the same) is apparently closing shop. 

I know the blogger had gotten a lot of pressure from those who wish to cheer-lead the surgery because she had mentioned that several times but it mostly, seems that the more involved she became with providers, the less she seemed to want to blog candidly about what she experienced on the negative side of WLS.  Providers started asking her to speak at their booths, and paid for her trips to conventions... when that started happening, I wondered how long her candid blog would continue - it's difficult - next to impossible, to refuse those types of perks, especially for a young mother whose disability (epilepsy after WLS) kept her from working and that's exactly how those who have had a difficult time with the surgery tend to be silenced - that or settling lawsuits out of court in exchange for the patient's silence about the repercussions from their WLS surgeries. 

I've stuck in so long (since 1999) because I have not had WLS and thus there is nothing they can really offer me to shut up (although I know my name is not spoken with love in many WLS circles).  One patient, Trish Hargis (RIP) called it the "conspiracy of silence". Trish courageously got on "Obesity-help"  which is financed by the WLS industry, as well as wls_uncensored listserve, and talked plainly about what she had experienced but unfortunately, her WLS contributed to her early demise at the age of 54.  I see so many folks go into weight loss surgery without knowing that, at best, with a lot of work on a daily basis and blood work every 6 months etc, the WLS surgery can only offer them a 2% greater chance of keeping their weight off than going at it with a non surgical program like Weight Watchers (Mayo Clinic study early 2000's for one - Swedish Obesity study for another). 

Sorry to see that blog go - it was a good one....

Tuesday, February 18, 2014

Another one lost


One of the most difficult things with being involved with weight loss surgery patients is when one observes people passing on, way too early.  A couple of years ago, I lost my bestest friend ever (pictured above) - she was a VBG patient which is a stomach stapling only - the surgery worked for her for about 12 years (with a lot of hard work on her part) and then, she got very ill with fibro and lots of other things to the point where in her early 50's, she not only gained weight very easily, eating very little food, but was basically bedfast.  She was a highly intelligent lady and her courage was amazing. She would boldly post about WLS, warning people despite getting numerous "nastigrams" in the mail. We chatted on the phone daily and shared everything with each other.  Then one day her husband called, distraught.  He had come home to find her deceased.  At the age of 54.

I don't understand why folks write nasty emails to people who try to present a realistic view of WLS.  Basically,  it seems, that pre-ops who want to believe the dream and new post ops who have lost a lot of weight and are thrilled at this, seem to feel that people should post nothing negative about WLS least a person might be "denied" this "life saving" surgery. 

Trouble is, in all these years, I've not seen it save any lives - on the contrary.  Cash cow, definitely.. and one WLS surgeon told me laughingly, "I bury my mistakes!"  It's true that dead people don't talk.

Lately, another patient has died, probably earlier than would have, had they not had WLS.  This patient had had the duodenal switch which is a surgery which calls for cutting away 90 percent of the stomach and bypassing most of the small bowel.  They lose weight well but in the long run, it's almost impossible to replace the nutritional deficiencies.  Less than 25% of the surgeons in the USA do the duodenal switch as there are safer procedures available but they don't want to openly diss it either, even if they have stopped doing the procedure because they are worried about lawsuits (and many surgeons have multiple lawsuits pending).

This patient was 57 or 58 years old and had their surgery in year 1999 or 2000 - was very pro surgery and very much angry that I dared to say anything against it.  Was a young person with their life ahead of them and now they are gone like so many other of my WLS friends, died from lack of nutrition, it is thought.

The truth about any WLS is not only do people have to do the same things that non surgical people do to keep off the weight but also, they have to have regular checkups and take a lot of expensive supplements, in other words, work very very hard to keep off the weight, and even then, they might not have a good prognosis.

I have a cousin whose BMI is over 75 - she is 77 years old and going strong.  Had she had WLS, she probably would not have lived to that age.

It's ironic that in this day of super communications, things which should be  communicated, somehow may not be. In other words, if it's too good to be true, it probably isn't.  There is no easy way out and certainly not having surgery to lose weight!

Tuesday, November 05, 2013

Weight Loss surgery stories or -- ads?

The latest news on Weight Loss surgery reminds us that the media openly admits they don't feel obligated to tell the truth. And often when they report on weight loss surgery, they do sneaky ads.  Weight loss surgery of any kind doesn't really help patients to keep off the weight.  After they have invasive surgery to lose weight, they are told that if they don't diet and exercise, they will not keep off the weight.  But diet and exercise will keep off weight whether someone has had surgery or not.  Medical providers do not give the public "informed consent" for medical procedures.  "If we did tell the public about repercussions," a medical provider friend told me, "they wouldn't have any procedures done!"  As if this is a valid reason for not warning folks what might happen and especially after elective procedures like weight loss surgery.


 Lately in the media, we find a questionable study and a story which emphasizes how a couple keeps off weight - one of them who had a gastric bypass and the other who did it without surgery.

The study looked at se/x after weight loss surgery and declared that it's better after weight loss surgery.  Anyone who knows a significant number of weight loss surgery patients like I do, will ask, "how can this be when erectile dysfunction is very common and especially after gastric bypass?"  Easy answer - the researchers studied women - no men!  The women studied were a couple of years post op - and it was a study in which the cohort were surveyed 1 and 2 years after surgery and reported more reproductive hormones and better se/x!

First of all, the study was financed by Ethicon Endo which makes instruments for weight loss surgery - can we say "conflict of interests"?  Secondly no men were studied - had they looked at men, they would have found a different story, especially longer term like over 3 years.  The news story sounds like weight loss surgery is a great deal, but the truth is more sobering - since men were not studied, the fact that many men get ED after weight loss surgery stays unreported (unless you read the long term weight loss surgery communities).  It should be noted that many patients who regain after weight loss surgeries are encouraged to not attend support meetings and not tell those around them that they have had weight loss surgery. Meanwhile many surgeons parade the slim 2 year post ops at support meetings, giving the impression that "everyone" keeps the weight off.  One longer term post op who cannot eat more than 1200 calories a day without gaining, also came down with epilepsy after a gastric bypass and found 150 more patients with the same repercussion - this patient is considering having brain surgery rather than having the gastric bypass reversed, despite the fact that the seizures are likely from vitamin deficiencies which would be fixed with a reversal.

As for the weight loss story, in a story entitled "No Magic Bullet for keeping off the pounds", a couple, both of whom lost a lot of weight, are interviewed.  The man lost weight without surgery and the story emphasizes how he is having a hard time keeping off the weight.  The lady had a gastric bypass and we are told she's kept her weight at 160 lbs for 3 years.  In this story, if the reader looks at the photos, s/he will see that even with a slight weight gain, the man is not only slimmer than the lady but he is in better shape also.  But if the story is read superficially, the take-away message is that people have a much easier time keeping off the weight with weight loss surgery.  

In  other words,  the story hints that weight loss surgery is "the easy way out".  Any weight loss surgery patient will tell you it's definitely not the easy way out and many patients have regained at the 10 years post op point - even with extremely invasive surgeries like gastric bypasses.  This is a reality which may never get to the public if they confine their reading to news media. 

 I am reminded of the patient who called me up, crying, after her gastric bypass.  "They never told me about the side effects," she told me also adding that her surgeon no longer answered her calls.  And for patients who do keep off the weight, how many of them can no longer eat?

Should it really be "buyer beware" when we are talking about surgery after which 2 percent of patients die and 30 percent have serious repercussions including requiring additional surgery?



Sunday, September 22, 2013

Guest blog - Daily Life with a gastric bypass



In this guest blog by Lisa Sargese, a college professor, who had a gastric bypass several years ago, she details how it feels to fight one's digestive tract at every meal.  I can relate because I have a bad case of GERD (hiatal hernia) - that and a bad medical procedure I got talked into called an "esphagoplasty", causes me a lot of grief in swallowing anything non liquid as my esophagus is narrowed and very scarred and does not conduct the peristaltic wave very well at all (the foolish procedure I had was that they blew up a balloon in my esophagus to supposedly, help the narrowing from the GERD - they said it would only last 6 months but I could have it done again... as I had a bolus of tuna firmly stuck in my lower esophagus and could not even keep water down, I was not really in a mood to bargain or question the medical profession - I was ready to have it done again, when in 6 months I experienced increased difficulty in swallowing, but then, I met a fellow who had had several of these esphagoplasty procedures and now was so scarred, he had a difficult time swallowing water - I decided against another esophagoplasty).

As people rush to get on the weight loss surgery table, they don't realize what it means to fight your GI tract at every meal, to plan how you are going to "get through" outings in a society where sharing a meal is the glue which brings friends and family together, how it feels to stand in front of some dirty restaurant toilet, trying to "get up" a piece of food which got stuck on the way down. Please read the following - it is very well written and very true.  Lisa has given her kind permission to me to reprint this:

 "A common misunderstanding
of gastric bypass surgery
 is that the pouch causes weight loss
because it is so small,
the patient eats less.
Although that is true for the first six months,
that is not how it works.
Some doctors have assumed that poor weight loss
in some patients is because
they aren't really trying to lose weight.
The truth is it may be because
they haven't learned how to get the "satisfied" feeling
 of being full to last long enough....
 it is NOT the size of the pouch
but how it is used
that makes weight loss maintenance possible."

- Pouch Rules for Dummies


Let me just preface this rant with the declaration that I don't believe weight loss surgery leads to overall good health. It may provide you with short term or drastic weight loss but it will cause side effects that make it not worth the pain and suffering.  Don't bother leaving me a comment to the contrary. I've heard it all. I've been called "bitter" and "a failure" and been yelled at for discouraging people form getting this "life saving surgery". I will glance at your comment and delete it.

That being said, let me tell you about overful pouch syndrome. It feels like dumping but it ain't.  It's when the pouch stretches too far and too much food needs to be processed. The symptoms are frightening: rapid heart pounding, weakness, dizziness, pain, pressure,and a sudden need to raise your legs higher than your heart no matter where you are.

Now, you mean-spirited, pro-wls cheerleaders are going to say that I should have learned by now exactly how much food I can tolerate. Let me school you. I am able to tolerate less and less food over time. I had my rny gastric bypass in 2006. I can now tolerate half of what I could eat when I first started this awful "journey". Different foods cause different reactions under different circumstances. It's always a surprise. I can eat and process less and less food.

One might think this is good news. One might expect me to be delightfully thin by now.

WRONG.

I fight fatigue due to my inability to take in enough food to give me the energy I need to live my life.

I can't tolerate protein shakes and never could.

My metabolism has slowed to accommodate my miniscule portions of food. I'm a sluggish, tired, cranky f*ck for a major portion of my day.

I have to load up on sugar and salt just to give me the energy to teach my classes.
When I'm hungry I can never eat enough to truly satisfy my hunger. The overfull pouch symptoms begin before I can get enough food into my body.

And so it goes...

Special occasions are difficult. Going out to eat is difficult. Social eating is difficult.
I have to gauge when I've had enough and put the fork down in time. Since there is a delayed reaction between swallowing and the food reaching my poor pouch, I often take a few bites too many. I pay dearly for every mis-bite.

Different foods produce different levels of discomfort. Sometimes I can eat a big salad. Sometimes I can eat lots of fruit. Sometimes I'm wrong and mere orange juice will cause the symptoms. It's a crap shoot every time I pick up a fork.

This weekend my brother and sister in law are visiting from Vermont. We had a lovely dinner at a Thai fusion place in Montclair. After dinner we went around the corner to Coldstone Creamery. We each got child's portions of dessert. We just wanted a taste. I took one spoonful too many. I had to explain why I was sighing and burping and roughly exhaling as I drove home.

I hate the weight loss surgery sales pitch. I was promised one thing and am experiencing another.

Satiety is not possible with water, I don't care what the literature says.

Protein shakes are odious. I am nauseated by them after the first sip.

All the tricks for feeling satisfied on a subsistence level of food don't work.

Our bodies are more complex than what the wls people want you to believe. Feeling satisfied after a meal is not just a function of the pouch or the stomach. Our bodies signal their need for food in many ways. Trying to cheat that system leads to a deficit, a debt, a bill that we have to pay to our bodies. Living on post-wls diets lead to problems, I don't care what the cheerleaders tell you. Some of them outright lie. Some are experiencing symptoms that their doctors won't admit are directly related to their weight loss surgery. Some are so delirious from being thin they ignore other areas of their physical existence. Many have stalled or gained weight back and disappear from the scene for fear of the shaming that comes from the cheerleaders and the medical people themselves.

My brother and sister in law are here with Theodore and Tilly Bear of the Teddy Bear Monastery founded by my brother. I'd like to enjoy their visit without having the burden of worrying that one bite too many will give me heart attack symptoms. That's not how it goes with wls. I'll be spending huge portions of their visit in major discomfort. I notice it more when I'm with people and when I'm eating outside the home.

Wls is the forever-f*ck-you for being fat. It is the forever-f*ck-you for being convinced that one has an eating disorder that only surgery can keep in check.

Every single time I eat I am reminded of my decision to alter my insides in an effort to be acceptably thin. I am reminded of my decision that I needed surgery to help me manage my eating because I decided I was untrustworthy as a self-caretaker.

Every single time I eat.
Every single day.

by Lisa Sargese, M.A.

Please consider subscribing to Lisa's blog - it's very interesting, inspirational and more!

Sunday, August 25, 2013

Gastric bypass - the holy grail of weight loss surgery?


The holy grail of weight loss, is hoping that somehow food will not appeal to us so we will lose weight.  A new study states that weight loss long term ( 10 years) is better after gastric bypass than after getting the lap band.  And why is this?  Because food is not as appealing to gastric bypass patients, the researchers found.

Well, true, a good percentage of gastric bypass patients get reactive hypoglycemia which means you feel really crummy after eating a plethora of foods, not just sweet stuff. (The patients refer to this type of becoming ill as "dumping")

The problem is, if you are getting sick after eating and you lose weight, that doesn't really count.  Because cancer patients and terminal AIDS patients also lose weight from being sick, but it's so not worth getting sick to lose weight.

What they are hoping you don't know about is for one, the Roslin study which found that 3 months after a gastric bypass, the appetite comes back worse than before surgery in many patients.

This clinical study of 63 gastric bypass patients (that means the researcher, a gastric bypass surgeon himself, actually examined the patients), also found that many of these patients had "glucose abnormalities" which would, in part, explain their voracious appetites.

Bottom line - to lose weight by getting sick after you eat?  Life is just too short for that one, you may well find.  5% of people on non surgical diet nutritional programs can keep off the weight.  7% of weight loss surgery patients (all surgeries, several studies) can keep off the weight.  But that extra 2% which isn't very much of a differential, is counting those with "glucose abnormalities" and other health problems after weight loss surgery.

Dr Terry Simpson tells us that success with Weight Loss surgery (any procedure) is 10% the surgery and 90% the patient.

So after taking rather serious and sometimes life threatening risks to have one's digestive tract rearranged, you can see that it is not very much more effective in keeping off weight than is a non surgical program.

Looking at things this way, the seeker should also be aware that merely embracing a healthy lifestyle of mostly wise food choices and cardio exercise 5 days a week will keep you healthy at any weight.(Lee CD, Blair SN, Jackson AS. Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men. American Journal of Clinical Nutrition. 1999 Mar;69(3):373-80)

Ask yourself, in view of the foregoing, is weight loss surgery really worth the risks?

Wednesday, August 21, 2013

We get angry letters sometimes....

We get angry letters sometimes ...

Wayne B, a gastric sleeve patient (and I would bet a "new op") writes the following:

Regarding the concern about nutrient absorption. You don't absorb nutrients in your stomach.. You absorb them in your small intestine and that is not touched by the surgery. Sue W rabbits on about here six years worth of success being enough o prove her point but demands ten years of success from a WLS recipient. Bit of a hypocritical double standard. on gastric sleeve story

Wayne, if you do not DIGEST food in your stomach then you cannot absorb it in your gut.  You digest proteins and fat in the stomach ... And vitamin B12. Before you get so self righteous, wait ten years... Wait until you get post gastrectomy syndrome... I've never met even ONE long term patient who was happy they had the surgery but because they get so much flack from the Weight loss surgery community, many are afraid to speak out...did you ever wonder why there is such a high rate of suicide among weight loss surgery patients or have you not read about that one yet?

Wayne further writes...

"SueW. You sound like a bit of a self righteous b*tch but hey thats your choice. I tried everything, and I mean everything so don't come back with some Whica health drink BS. Gastric sleeve saved my life so how about you crawl back into your health nut whole and leave people who are trying the best they can alone. on gastric sleeve story"

(Note I have left Wayne's original spelling! :) :) ) My word, Wayne, why so defensive that you feel the need to be ad hominem (that means insulting in case you wondered!).  I'm trying to get informed consent to folks like you because I have met countless patients who find about the repercussions of weight loss surgery, after the fact.  About 50% of those who know the risks, will go ahead and have surgery...the other half will skip it... (especially when they find out they need to diet and exercise to keep losing weight or at a lower weight!)  People deserve to know if there are any deal-breakers in the repercussions.  Many people who have surgery think they won't have to count calories etc to keep slim and nothing could be further from the truth.  The more invasive the procedure, the longer a patient might lose his/her appetite but when it does heal, the appetite comes back, with vengeance.

I've been in this for 14 years and from what I've seen, most of the folks who really hawked the surgery, as pre ops and new ops, when they start getting sick, (and often regain the weight), they get quiet and don't warn pre ops about what could happen after surgery.

Bottom line, no weight loss surgery saves your life...YOU save your life!  As Dr Terry Simpson says, "Success with weight loss surgery is 10% the surgery, and 90% the patient!"

And successful weight loss surgery patients do exactly what we non ops do. ...they journal or keep track of their food intake and exercise... Keeping weight off is work on a daily basis whether people have had surgery or not.  But in addition, weight loss surgery patients have to have frequent expensive blood work, drink protein shakes to avoid protein deficiency and take a lot of vitamins in addition to logging their food and exercising.

A sobering fact... A friend of mine who weighs in excess of 550 lbs says she's outlived 48 of her friends who had weight loss surgery.

According to the few studies which have looked at long term patients, only 2% more of wls patients keep off the weight they've lost.  That is 5% of people keep the weight off without surgery.  And 7% of weight loss surgery patients keep off all of their weight.

There is no such thing as "life saving weight loss surgery"... People save their lives, not any weight loss surgery.  Please don't fall for the used car hype!