Tuesday, May 27, 2008

bogus claims in the news - gastric bypass extends life?

Today I was chatting with some friends and someone brought up that some media column writer said you didn't have to put mayonnaise in the fridge. Mayonnaise has eggs in it for one and in my experience, gets rancid fast if not refrigerated. Everyone in the discussion did feel that it _should_ be refrigerated and since a media person said it didn't have to be, everyone seemed to feel that must be right.

Media is seldom if ever right. If they are not selling something, they often do poor research (this is partially because of tight deadlines which precludes doing careful research so they often look up the subject in other media articles which are just as poorly researched - a case of the blind leading the blind?). But the fact remains that too many people actually believe what the media prints regardless of how "over the top" it is!

Case in question. Here is a paragraph I found in one of the blog searches:

A Gastric Bypass Really Can Extend Your Life

If you are contemplating having a gastric bypass then a recent US study might just help you to make up your mind. The study looked at no fewer than 16,000 obese people and found that when people in the study group opted for gastric bypass surgery their long-term mortality rate dropped by as much as 40%. This should not really be a surprise since weight loss surgery also cures, or at least improves, a host of other conditions such as high blood pressure and diabetes and the change in diet and increase in exercise which follows surgery has got to be a good thing. Nevertheless, it is always nice to see what we already know put down in black and white as confirmation.

Of course the study is not cited and it all sounds good - if you don't think about it. A gastric bypass provides for the stomach to be cut into two pieces - one tiny piece which becomes the "pouch" and the rest of it (about 90 percent or more) which is bypassed along with the attached first segment of small bowel. The bowel is cut into pieces and rearranged in a way very different from the way nature made it. All this causes a quick weight loss during the first year or so and lifelong problems including vitamin deficiencies, osteoporosis, anemia, protein deficiencies and much more.

As Dr Terry Simpson put it:

***The RNY [gastric bypass] trades one disease for another: it trades obesity for malabsorption. By re-arranging your guts you sometimes have severe side effects, and can have long-term problems such as iron deficiency anemia, calcium deficiency leading to osteoporosis. (Dr Terry Simpson, MD, WLS surgeon)
So how would this extend your life? Well, the idea here is that fatness is so deadly that any way to slim down regardless of unhealthy it is, is better than being fat. But there are no real studies which prove fatness in itself is deadly! And when they mention all these ills which are supposedly exacerbated by fat, does anyone question that slim people have the same ills i.e. high blood pressure, diabetes etc? I think the problem is people don't question something they read in the media. And that is where the problem starts.

But let's take a closer look at the study they referred to. It was one led by a WLS surgeon, Dr David Flum and he found in the study (which the media happily ignores) that the first month after a gastric bypass, 2 percent die and that another 5-7 percent of patients die within the first year (these were older patients so had bodies less tolerant to the extreme internal rearrangement done in the gastric bypass).

So how does he conclude that gastric bypass extends life? He compared these 16000 healthy fat people in for gastric bypass to 2000 seriously ill fat people in the hospital for other reasons and observed that since there were a small number of more deaths among the seriously ill fat people than the gastric bypass patients, that meant that the gastric bypass must have extended the lives of those who got it.

What he hoped the public would not realize is that had he compared the gastric bypass patients to 2000 seriously ill slim people in the hospital for other reasons, he would have also found that the healthy fat people who had gastric bypass survived better than the seriously ill slim folks. So would that mean that slim people should have a gastric bypass to "extend" their lives?

In another blog article
A nice looking couple is pictured. They are fat but not terribly so - they are both having gastric bypass surgery. The lady, it said, has high blood pressure even with being on 4 medications and the man has bad knees ("worn out from carrying all that weight").

Here's another which should be questioned. Most of the people I know with really bad knees are not fat. Some have never been fat in their lives - so how did their knees get bad without the "great weight" weighing down on them? And if a person's blood pressure is that high with 4 meds, did they really think a gastric bypass is going to bring it down that much? Again I know several slim people with very high blood pressure. The bottom line is, will introducing a surgical disease into their digestive tract make their health better? Perhaps or perhaps not - it all depends on whether their present comorbidities are greater than the comorbidities added by the bypass. But the media tells us that the bypass is some kind of magic bullet which fixes all ills and no one questions this and that is what is of concern.
***** "By doing this surgery, you're creating a medical disease in the body. Before you expose someone to that risk, you have to be absolutely sure that you are treating an illness which is equal to or greater than the one you are creating."
(Dr Edward Livingston, bariatric surgeon in Self Magazine, 4-2001) *****

Today I saw an ad for something about diabetes featuring as a poster kid, Randy Jackson. I did a double take. Jackson had a gastric bypass a year or two ago and that was supposed to have cured his diabetes (if you believe what the media tells us). I read the ad carefully. It said he was taking less diabetes meds now after his bypass but that is a totally different story than his diabetes getting "cured".

Fact remains, we are suffering from many old age diseases including worn out knees and high blood pressure because now we are living to the age where people start wearing out, fat or slim.

I commented on the widespread practice of smoking in Indonesia. "Doesn't that shorten their lifespan," I asked my hubby. He answered, "They don't live long enough to die from the repercussions of smoking."

I have known countless people who had gastric bypass to fix their knees only to find that the malnutrition and vitamin deficiencies made things worse if anything.

We need to start questioning seriously what we read in the media. If we follow their advice to not refrigerate our mayonnaise, we might get an upset stomach. But if we follow their advice to get a gastric bypass, the repercussions can be much more devastating.


fetchfox said...

I'm only commenting on the mayonnaise/miracle whip portion of your post. It's true that both condiments do have to be refrigerated after opening. However, both are shelf-stable before opening. (before breaking the seal to the container)

Depending upon ones preferences, they can taste really nasty at room temperature. Which may be why some people prefer to chill their preferred salad spread, mayo, condiment, etc. prior to use.

I wish I had access to where your friend read/heard this from. I'd really like to read it.

Nan said...

Amen. Every person I've known who had to have joint replacement surgery (knees, hips, ankles) had it because they suffered from rheumatoid arthritis, had damaged the joints through playing sports, or were really, really old and the bad joint was the result of osteoarthritis. None were fat except a lady with RA -- and the excess weight was the result of her RA meds. I know anecdotal evidence doesn't count, but after years of hearing "you've got to lose weight or you'll destroy your knees" and then seeing people much younger and thinner than me spending zillions of bucks on orthopedic surgery. . . I do question the causality of weight as it relates to joint damage.

Ditto cholesterol. The highest numbers I've ever heard were on people that, based on their weight alone, were totally healthy.

As for WLS -- my old primary care physician said he absolutely refused to condone it for any of his patients. He's associated with a research hospital, has a long term interest in weight and health, and has been following WLS since it first began being touted. His conclusions were that it was too high risk, the side effects were too nasty, and, most damning of all, it doesn't work. Given time most patients regain the weight this miracle cure was supposed to take off permanently.

Lacy said...

>Media is seldom if ever right<

Such generalizations really don't help your case, Sue. I enjoy your blog and appreciate how you get beyond the headlines and spin.

But your comment suggests a lack of critical thinking. Are you really saying that media coverage is usually or always wrong? That makes no sense.

It's often incomplete, and in terms of covering health-related issues, it often misses the point. But if you are going to dismiss all "media," you might as well start burning books and living in a cave.

The FA movement needs to continue promoting intelligent discourse and critical thinking. "Media is seldom if ever right" sounds more anti-intellectualism. And I don't think that's what your blog is about.

Sue Joan said...

Nan, great comment - You have a great PCP - I wish there were more like him! thanks!!

Fetchfox, in answer to your question about mayonnaise it was Heloise in a column in the newspaper - I was informed this by someone else, but this morning, in researching, I could not find a link to the column. I only found one reference to Heloise saying that (in a message on usenet) but, in the following reference, a book of the "best hints" published in the 1990's and written by Heloise, she says Mayonnaise lasts 2-3 months UNOPENED on the shelf and 6-8 weeks refrigerated after opening (obviously pointing out that it DOES need to be refrigerated after opening!). I suspect that if she had written, years ago, that it didn't have to be refrigerated after opening (which is possible - I remember when I was a kid, many people did not refrigerate their mayonnaise) she's obviously modified her statements with the advent of a greater understanding of bacteria,and food poisoning... as a matter of fact, her book written in 1999, contains a long explanation of how bacteria grow in food etc . Here's the link to excerpts from this book including the blurb on mayonnaise and also food poisoning:


This points out something else interesting - the media upon which the public places so much reliance, is very "of the moment" but when the same writers do a book, their research tends to be better and statements can change drastically. (We saw this in the difference with Gina Kolata and obesity research, before and after she wrote her book, RE THINKING THIN). Thanks for your comment - it ended up in an interesting research! :)

Sue Joan said...

Lacy, good comment! You are absolutely right - that wasn't well worded at all. What I should have put is that the media is seldom IF ever, correct ABOUT obesity. But if you read the rest of the blog, I meant to express that we need to think critically about EVERYTHING we read and also to research things we read in the media because especially on certain issues, they can be very wrong. Sorry for the misunderstanding. Hopefully, they will read my blog (and your comment and this comment)and get the gist of it. :)


Anonymous said...

Okay, so who eats a jar of mayonnaise in 6 to 8 weeks? That's absolutely ridiculous.

< snarkycomment >
Maybe that's why so many Americans are fat? They go through jars of mayo every two months.
< /snarkycomment >


Unknown said...

The methodology used in that study is shameful. Talk about setting something up to guarantee that you arrive at your desired outcome.

I have known countless people who had gastric bypass to fix their knees only to find that the malnutrition and vitamin deficiencies made things worse if anything.

This has always been my suspicion about WLS. I don't think we really have enough years of data on the "new," "good" versions of WLS (Roux en Y, Duodenal Switch, etc.) to tell, but I suspect that making such a radical change to your digestive system cannot possibly be less dangerous (by which I mean result in a longer lifespan) than simply remaining fat, especially in the majority of cases where you are fat due to your genetics and not due to temporarily "eating yourself above" your setpoint. (Of course, most people think all of us fall into that second category, which is always great.) Anyway, I hope I'm wrong because there are tens of thousands of people having these surgeries, and I don't want them to get sick or die earlier than they would have otherwise.

As to diabetes, I heard somewhere recently (maybe it was wellroundedtype2?--Yep, here it is) that consuming fewer calories may improve diabetes symptoms regardless of whether you lose weight as a result or not. From that I can see where it would be very problematic for most people (who have never had an original thought about fat and health in their lives) to separate "dietary changes may improve diabetes" from "weight loss cures diabetes" (because of course if you are fat, you're eating crap and tons of it) from "gastric bypass cures diabetes." After all, the only thing you are more or less guaranteed after WLS is that you won't be able to eat as much food as you were eating before. That may or may not improve or delay the onset of your diabetes symptoms. But that doesn't mean this is necessarily an overall positive development, or good for your health on the whole, or that you will live longer as a result.

OT, I agree with dayna regarding mayonnaise. I've just resigned myself to the fact that I'm going to have to buy a whole new little bottle of it every time I need some for a recipe (deviled eggs or a casserole or something). I don't think my guests would appreciate me using the 6-month-old stuff from the last time I made anything containing mayonnaise. :P

Sue Joan said...

Dayna, :-)

Jennifer, Good point... and interesting comment about less food helping diabetes but I wonder about those with diabetes type II who are very slim who are already restricting their calories greatly. (about 33 percent of diabetics TYPE II have never been fat). The really slim ones seem to be the most brittle diabetics I've known i.e. have the most difficult time keeping their blood sugar levels down. Perhaps it is that eating too little food can be as bad as eating too much food? Diabetes is a strange disease. The media acts like it's a no brainer - have a gastric bypass and you will be cured. or lose weight and you will be cured. Unfortunately the reality is quite different. My FIL who was trim and slim and fit all his life, came down with type II diabetes about the same age that my DH came down with it and FIL ended up losing both his legs from it. (but never became fat even after he was in a wheelchair as a double amputee). Perhaps if medicine spent less time on obsessing over fatness and more time really studying the disease which happens to BOTH fat and slim folks, they might develop a better understanding of it. Wow, what a novel concept! :)


Anonymous said...

I agree with what you say about people not questioning the news. It's amazing how gullible people are, and how they put their own lives at risk by not doing their own research.