Friday, September 11, 2009

New Scientist Magazine and gastric bypass

In the Sept 2nd issue of the "New Scientist" Magazine, they have an article about gastric bypass.

The article presents the surgery in a very positive light, mentioning virtually no serious repercussions (like reactive hypoglycemia, epilepsy, B12 deficiency leading to pernicious anemia or iron deficiency anemia, ulcer, bowel obstruction etc), advocating it as a "cure" for diabetes as well as obesity:

Clearly these drastic procedures will cut your calorie intake, but here's the strange thing: the operation is much more successful than anyone could have expected. Even though they can't eat as much, people who have undergone surgery are not constantly ravenous, in stark contrast to those dieting through will power alone. It seems the gut normally secretes hormones that make us feel hungry or full, and bypass surgery ramps up production of the ones that make us feel full.

This article also includes long, pseudo scientific explanations of why this surgery "cures" diabetes and makes you feel full - they attribute it to changing gut hormones (of course, they don't say how this occurs and not surprising, they only mention a rat study or two as documentation for their claims).

I say, not surprising, because they really do not know _what_ controls appetite nor exactly what those gut hormones do. And also, the temporary lack of hunger in new ops is easily explained by the sudden difficulty in eating (food can get stuck etc) and the massive healing going on inside after the small bowel and stomach have been cut into pieces and put together in a very different manner from what nature intended.

And interestingly enough, human studies have tended to show that these surgeries are not particularly successful as for maintaining weight loss on the long run. For example:

  • A study of 10 year post op gastric bypass patients found that 34 percent of those who started with BMI 50 or over, had regained all or most of their weight (REF: Annals of Surgery. 244(5):734-740, November 2006. Christou, Nicolas V. MD, PhD; Look, Didier MD; MacLean, Lloyd D. MD, PhD)

  • The Swedish Obesity study found that at the 10 year point, the average BMI was 35 evidencing a significant lack of weight loss retention. (REF: New England Journal of Medicine: Volume 351:2683-2693 December 23, 2004 Number 26 Lifestyle, Diabetes, and Cardiovascular Risk Factors 10 Years after Bariatric Surgery Lars Sjostrom, M.D., Ph.D et al)

  • the Hebrew University study found that only 7 percent of gastric bypass patients had kept all their weight off- and that 25 percent of patients had regained all their weight back (or more). (REF: Dept. of Surgery C, Soroka Medical Center, Beer Sheba (Israel study) Harefuah 1993 Feb 15;124(4):185-7, 248 (article is in Hebrew))

But worse yet, a new human study found erratic blood sugar levels in most of the patients studied (clinical study) which caused them to be _ravenously hungry_ soon after meals - this study directly disproving the claim that the gastric bypass somehow changes the gut hormones to kill the appetite.

A clinical study of 63 gastric bypass patients by Mitchell Roslin and associates, has disproven this theory when it found that not only did 80 percent of the gastric bypass patients in their study suffer a RAVENOUS appetite soon after meals, but also experienced the almost uncontrollable urge to eat which did for many result in weight regain after the first year (the study went for 4 years). The researchers also found that 80 percent of the patients also had undiagnosed "glucose abnormalities" including "high blood sugar" or "low blood sugar" or both. Dr. Roslin reported on this study at the 2009 ASMBS convention, suggesting that the gastric bypass may cause a heightened insulin response due to the rapid emptying of the pouch into the small bowel.(ref: Roslin M, et al "Abnormal glucose tolerance testing following gastric bypass" Surg Obesity Related Dis 2009; 5(3 Suppl): Abstract PL-205.)

The so called "cure for diabetes" also attributed to the elusive gut hormones by this article, has only been called a "cure" in the media. Any studies which suggested that weight loss surgery got the blood sugar levels down to normal in diabetics, called it a "remission" and what long term studies we have seen (for example, the Swedish Obesity study), found that at the 10 year post op point, only 36 percent of diabetics were still "diabetes free".

Additionally, as observed in a friend of mine who was diagnosed diabetes, 16 years ago - six weeks on the Weight Watchers Momentum program reduced his sugar levels to normal also even though he only had lost 12 lbs of weight and still was significantly obese.

Any gastric bypass patient will tell you that this surgery is NOT the "easy way out" but in fact not only takes a lot of work to maintain weight loss but also to make sure one gets vitamins, supplements, B12 shots and iron infusions (which patients need as time goes on) and close medical followup required. Gastric bypass has been observed to cause some alarming repercussions in many patients over 6 or 7 years post op.

In fact even a significant number of newly operated gastric bypass patients suffer repercussions:

In a radiologists' study, they looked at 72 gastric bypass patients and found by CT scanning, that 41 of the 72 patients i.e. 56 percent) had some 62 "abnormalities" in their digestive tract. The "abnormalities" included leaks, hernia, spleen and kidney damage, hematoma, bowel obstruction and distended excluded stomach. (REF: Diagnostic Imaging - September 2, 2004)

And if healthy food choices, slight calorie restriction combined with exercise, can reduce sugar levels even in a diabetic diagnosed many years ago, one would wonder why a person should even consider getting one's digestive system permanently surgically changed.

Articles like this one in the "New Scientist" do a lot of harm in misleading people to make permanent changes in their organ systems, a move which many find does NOT work real well for them but can give them a whole new set of co-morbidities and a lot of grief.


wriggles said...

Well said, excellent.

The front title page sums it up, 'gone appitite', celebrating the end of someone's appetite. Which often happens to people when they are dying and is indeed a sign of the end of lifeforce. Fighting hunger is like trying to extinguish life, you can tell they've not thought it through, but are acting merely on their unchecked neurosis about fatness.

As for the biology of it, it's a bit like mapping the brain, are you seeing the imbalance, or the brain activity of a mental crisis?

IOW, are they just seeing the operation of the digestion process in a fat person's body and saying, that's the cause (of fatness)? It is framing fatness as a disease that forces them in this direction, rather than observing it objectively as a phenomena, in the context of the whole spectrum of bodies, and seeing what comes out of that.

They are looking for the cause of what is a state of human existence, it's like same problem with looking for the cause of consciousness, and the end of the day it's academic, we exist, we are conscious, now, how to do go with biology, not against it as GBS does, to get the most positive results we can?

Unknown said...

This article annoyed me when I read it too - but I was happy to see (at the time) most of the comments disagreeing and pointing out the dangers of WLS.

The main point I like to make when people discuss WLS regarding diabetes is that in all the studies I've seen, the diabetes has gone "into remission" almost immediately, as in within a week or two after the surgery - long before any significant weight loss. This actually indicates that it is not the fat that has any impact on diabetes - there are now theories that the disease is actually related to chemicals secreted by part of the digestive tract which is removed during surgery.

Sue Joan said...

Hi Anarielle, thanks for your comment. There are a some interesting things about diabetes and surgery.

First, a day or two with no eating will immediately, bring the blood sugars down and gastric bypass patients basically eat less than 300 or so calories a day the first couple of days. That alone can explain the low sugar levels right after surgery. But secondly, hubby and I found out something very interesting - he's a long term diabetic DXed in 1994. In Feb 2008 he had a surgery to insert a ventricular shunt in his brain as a result of a hemorrhagic stroke. Before the surgery, when he was in ICU and they were giving him insulin shots (he was on orals but in situations like that they don't like to give orals), his blood sugar levels were in the mid 200's - he is about 60 lbs overweight. But right after the surgery which is a neurological surgery and has nothing to do with the digestive tract (so they're back on a normal diet right after), his sugar levels tanked and after he came home, for a month after that surgery it was almost like he didn't have diabetes because he suddenly could eat anything he wanted (and he DID - like fast food several times a week, Dairy queen etc - all the stuff he had abstained from before this "event") and his sugar levels remained at normal levels just with his oral meds. Strangest thing. Then, about a month after surgery, they started to creep up and soon were back at pre-surgery level. So it appears that SURGERY does SOMETHING to the hormones having NOTHING to do with the gut - ANY surgery it seems, even something totally unrelated like neurological surgery.

Fourth, after his doctor recently, threatened the NEEDLE (putting him on insulin!), he in desperation started in on Weight Watchers Momentum program. Within 4 weeks of his starting, his sugar levels were down to normal and he actually could cut down his meds a bit! But he'd only lost 8 or 9 lbs.

Finally, there have only been 2 studies on diabetes and WLS - in the first, it was NOT randomized and they ONLY selected people who had been DXed less than 2 years and at that point, any kind of lifestyle change will bring sugar levels down to normal (hubby managed for 13 years with no medication!). After WLS, they observed that 72 percent of patients went into remission (so see, some did not - even newly diagnosed patients). The study did not go long term (the Monash study). The other study, the Swedish Obesity study- at the two year post op point, observed a similar remission rate to the Monash study however, at the 10 year post op point, they found that only 36 percent were still in remission - for the rest, diabetes had returned. And of course, a new study found a significant number of post op gastric bypass patients get "reactive hypoglycemia" which is much more difficult to handle than diabetes.

Bottom line, WLS does NOT "cure" diabetes and the theories about "changing gut hormones" etc are likely invalid (although they are good for selling procedures.

Again, thanks for reading my blog and for your comment!