Sunday, December 23, 2012

gastrointestinal liner - or endo barrier

Another weight loss surgery? Oh, excuse me this is "not surgery" say those advocating it.

(Hubby says it looks like a condom for your guts!) :)

Of course it is surgery but there is no incision. That's what they mean by "not surgery". It's stuffed into your mouth, down your esophagus through the lower stomach valve and into the first couple of feet of your small bowel. What it does is prevent a lot of food from being absorbed.

Unlike the good providers who are pushing it say, it does NOT prevent sugar from being absorbed because sugar is mostly absorbed through the mouth and upper part of the stomach. They hope the prospective customer is (a) desperate to lose weight and (b) doesn't know much about the GI tract.

What is prevented from being absorbed is the good stuff, the proteins and fats (yes, you do need some fats to lubricate) but sugar? Absorbs just fine. So much for the resolution of diabetes which is not happening with this device.

If you think you've heard it all, there is more. 100 % of folks who had the "Endo Barrier" implanted, got at least one negative complication.

These can include bowel obstruction or nausea/vomiting or pain, and bleeding. You can also get a fever and "device migration" which means the long plastic tube they inserted, moves down through the GI tract. That might mean an invasive surgery to remove it since your small bowel is some 22 feet long and the lower parts of it are hard to get to. Not nice experience.

The providers admit this is a temporary device and you know what that means - as observed in Australia and places where they are inserting some of these, people tend to regain the lost weight.

So don't let the excited providers, giving a rosy picture of the endo barrier (which they are calling the "gastrointestinal liner") influence you. Likely this device is far more trouble than other procedures and not really effective in the long run.

Friday, September 21, 2012

Bariatric surgery safe and effective?

We've been there before.  Every so often they have a new study "proving" gastric bypass (particularly) is "safe and effective".  And when one looks at the studies more closely, one sees, that studies which turn out with positive results are not exactly, what they seem to be.

The new study published in the JAMA of September 19, 2012 (
Ted D. Adams, PhD, MPH; Lance E. Davidson, PhD; Sheldon E. Litwin, MD; et al.
JAMA. 2012;308(11):1122-1131. doi:10.1001/2012.jama.11164)  is no exception.  The American Medical Assn, publisher of this journal, offers a free read on this study (because it's basically an advertisement for gastric bypass surgery).

First of all, the mean BMI of the surgical group was 45.  However, the average BMI of the gastric bypass patient is over 50.

At the 6 year point, continue the researchers, 76% of the gastric bypass patients had maintained a weight loss of at least 20% (this was erroneously reported by the news services as 28%).  Apparently the 27.7% reported by the news service, actually referred to the weight initially lost and not that maintained

Doing the math, the average patient, 5'5" likely weighed 270 (BMI 45).  If they maintained a weight loss of 20%, they maintained a loss of 54 lbs leaving their weight at 216 and a BMI of 35 i.e. still clinically obese and if they are diabetic, still qualified for weight loss surgery!

And for this modest maintenance, they take the chances of the long term repercussions of severe vitamin deficiencies, including the B complex vitamins which can cause many symptoms from seizures to mental fog and gastro paresis (paralysis of the stomach), leaky bowel, lessened immunity, micro-nutrient shortages (zinc etc) and a host of other issues.

Doing the math on this doesn't make any sense, does it?  Of course, the news services and some providers hope you won't do the math!

Best if you want to have weight loss surgery, to choose a less invasive option but it should be noted that weight loss surgery patients do the same work that non surgical patients do, to keep off the weight. That is, if they do not diet and exercise, they will regain the weight, regardless of how invasive the surgery.  Al Roker, a gastric bypass patient, started to regain and told the "Today Show" folks that he not only runs several days a week but also counts his calories every day to keep off his weight. That behavior will keep off weight without any weight loss surgery.

The whole idea of weight loss surgery, how it is sold is, that it will make you normal and you can eat whatever you want and never have a weight problem again. At seminars, they often, parade 2 year (and more recent) post ops who are success stories but the small print on every surgeon's web site and in the consent forms, says you have to diet and exercise to keep off any weight at all. And if you have to diet and exercise, you can do that without surgery!

If it's too good to be true - it probably isn't.

Thursday, June 21, 2012

Dr Phil's sneaky ad for weight loss surgery

Dr Phil, on a re-run show, aired again this past week, recently featured a lady who had just been named "the World's Heaviest Woman" in the Guiness Book of World Records.  She weighs over 700 lbs.

The show was the usual anti obesity show and how this lady, Pauline Potter, was going to die soon and how Dr Phil was going to intervene like the knight in shining armor he feels he is.

The problem with the show was, it was very incorrect in the information given. I understand that reality TV is often not very real but seems that a show like Dr Phil should keep more integrity than that.

Apparently, according to Pauline's own website, she celebrated getting to over 700 lbs and sold videos of her moving around etc on this website. There is no indicator that she's not still selling these!

Also, the show first aired in November 2011 and Pauline and husband claimed they were divorced however, an article in late 2011, mentioned they'd gotten back together again, their love rekindled in L.A. in 2010.  Dr Phil had asked on the show if they had problems with intimacy and Pauline said they did not, but in two articles, the ex or now- non ex, admitted that they were afraid to have intercourse because they might break the bed.

Pauline told a couple of reporters she planned to lose 200 lbs in early 2012 because she and her ex - non ex husband wanted to have a child together (she has an older son from another marriage).

And Pauline, who weighed around 643 lbs when she appeared on Dr Phil, weighed over 700 lbs in Jan 2012 so the food Dr Phil had sent her had not appeared to help with her weight loss.

The strangest thing on the show was that Dr Phil introduced a Dr Ted Khalili as a "world renown weight loss expert" and offered Pauline, Dr Khalili's and his office dietician's help in her weight loss. What no one mentioned was that Dr Khalili is a weight loss surgery surgeon in L.A.  Pauline did mention in one article that she planned weight loss surgery but this was never mentioned on the Dr Phil show.

And strangest of all, is that the last mention of Pauline I can find is in Feb 2012.  Did she die from the weight loss surgery like the poor "Half Ton Mom" did?  Did she stay at her present weight or close to it?  If anyone has heard where Pauline is recently, do let me know. I very much, hope things went OK for her but having seen so many negative results from weight loss surgery, I cannot help wondering how she is now, especially that I cannot find any recent mention of her on the internet.  Also, in the cases of the very obese I've seen, weight loss surgery has not helped them. Often, they ended up gaining a lot of weight back - for example Allen from "Big Medicine" never did get out of his bed or worse yet, the weight loss surgery patients who started out very large, did not live like the "Half Ton Mum" of TLC who died 2 weeks after her gastric bypass.

All this to remind us that TV is for entertainment only - we should really hesitate to believe anything we hear on TV even from a source who seems so reliable, like Dr Phil.

Tuesday, April 10, 2012

Plastic Surgery after weight loss surgery

RNY-loose skin-

The following is from my notes watching a program called "The Real Skinny" on TLC.  (The Real Skinny, program on gastric bypass patients and loose skin on "Discovery Health".)

"after all my hard work, after all the foods I've cut from my diet, I still have to deal with my excess skin...  If I have to live like this all my life, I'd rather be fat again. " (male gastric bypass patient)

Dr Katzen has done many loose skin surgeries on gastric bypass patients.. His comments about operating on gastric bypass patients echo what many many other surgeons have said about it. Though being fat is thought to be very unhealthy, the fragility of these weight loss surgery patients raises the question that having a surgery which depletes the body of nutrients might be much more unhealthy that is, the cure seems to be, in some cases, worse than the "disease".

"A lot of surgeons are afraid of these plastic surgeries for a multitude of reasons...these surgeries are very risky surgeries ... I'm taking off a lot of skin, a lot of fat..."

"These patients are higher risk just because of their gastric bypass: they are typically malnourished... Just the fact that you've had gastric bypass increases the risk of bleeding, infection, and wound separation. For a circumferential body lift, I use 1000 to 1500 stitches...these surgeries typically take 8 hours... We pretty literally cut them in half and put them back together." --- Dr J. Timothy Katzen, MD plastic surgeon, Los Angeles, CA

Carnie Wilson, who admitted to have regained up to 250 lbs, 12 years after her gastric bypass surgery, was, none the less, much more fragile, healthwise than she was before surgery.  She said she was pre-diabetic and more.  It took her 4 weeks to recuperate after her lap band surgery...whereas her recuperation after a much more invasive surgery, gastric bypass, was much faster.  That is, she was much more healthy going into her gastric bypass despite weighing almost 300 lbs, (she's 5'1") than when she was when she went into her lap band surgery.  The difference was even though she weighed 40 lbs less than she did when she had the bypass, she had been not absorbing many vitamins and nutrients for 12 years.

When my DH had a brain bleed from taking the daily aspirin, there was another lady in the ICU - she had been over 300 lbs before her gastric bypass...her husband told me, tearfully, she was so frail now.  She did not survive.

Back to the show, Dr Katzen was shown doing a loose skin surgery on a male patient.

On this patient he did thighs and a circumferential lower body lift. There was a lot of fat left...

"we put him together with a type of super glue...the problem is too much super glue...the drain sucks out the fluid and allows the body to stick together."

"These patients usually exercise a lot to try and get rid of the loose skin but exercise alone won't get rid of the loose skin.  That's where I come in."

Dr J. Timothy Katzen, MD plastic surgeon, Los Angeles, CA

There is a lot of pain after these plastic surgeries for a few weeks after. "It's taking a lot longer to recover than I thought it would.". Four weeks after the surgery, the male patient was still not healed. He had a hole in his body about the size of an egg. "I felt wetness and my incision had opened up.", he told the camera crew. He had developed a staph infection in his open wound.

"we can't stitch up the open wound because if there is one germ left in there, they can develop a huge infection i.e. sepsis". Sepsis is a general body-wide infection from which there is a poor survival rate. This patient's relationship with his girl friend was strained, he said, and at filming they were hardly talking to each other.  He had a wound vac to suction out the hole.

It took him 6 weeks to heal and he still needed another surgery.

"my friends ask me why I want to go ahead with another surgery when I suffered all those complications, infections etc but I want to finish the job.", he explained.

Both patients have a huge scar which goes all around their bodies.

Note: part of Carnie Wilson's reasoning for having the "band over bypass" surgery is that she's got a job as a spokesperson for Allergan which manufactures the lap band.

The providers have nothing to lose. If the patient regains the weight or gets sick, they blame it on the patient...or quote statistics which suggest this type of reaction is very rare.  And if the patient lives and regains, the surgery is no longer mentioned.  If the patient dies or becomes very ill, the providers often make the patient afraid to speak out.

"I bury my mistakes" one gastric bypass surgeon joked to me.

In this surgery as in all commodities, it's a case of buyer beware.

Research sources:

"Wilson Phillips Still Hanging on" show on the TV Guide network

Thursday, March 22, 2012

Carnie Wilson - 2nd weight loss surgery

Carnie Wilson, singer and daughter of Beach Boy, Brian Wilson (pictured in red dress in photo with her singing group);  got a RNY gastric bypass, 12 years ago. She lost 150 lbs initially, and told the press, "It was so easy -- it was like I blinked my eyes and the scale went WHUUP!"

A frenzy of people signed up for gastric bypass surgeries. One person who worked for a weight loss surgery surgeon, told the news that every time Carnie Wilson appeared on TV, their phones rang off the hook!  The surgical group who did Carnie's surgery, dramatically simulcasting on the internet during her surgery and launching a huge publicity campaign in partnership with the manufacturer of surgical instruments, went from doing 5-7 weight loss surgery procedures a week to doing 12 weight loss surgery procedures a week.  The future looked rosy, for Carnie and the Weight Loss surgery industry.

But dark clouds were gathering on the horizon.

Soon after Carnie Wilson's famous quote to the press above, she began regaining the weight, despite fighting hard to keep her weight off, including, hours of exercise, engaging personal trainers, putting salt on desserts so she wouldn't be tempted and publicly humiliating herself, talking about her weight problem. By 2011 when she appeared on the Dr Oz show, she'd regained to her average weight before surgery, about 240 which is a lot for her since she's only 5'1".

Apparently, she lately, had a gastric band placed over her bypass to force a restriction of her food intake, and has lost 30 lbs so far.

The bottom line is the gastric bypass or any weight loss surgery, is no free ride.  Just like using a non surgical tool like weight watchers, it's a lot of work on a daily basis for the rest of your life or you will regain the weight and/or get sick!  A percentage of gastric bypass patients get sick anyway, even if they do everything right.

Carnie Wilson, like so many others, was given the impression surgery worked automatically and easily.

That so many people embark on weight loss surgery seemingly ill prepared for the reality, can be at least, partially blamed on allowing the mass advertising of surgery without requiring the advertiser to list side effects and disclaimers like "results not typical".  Some weight loss surgery surgeons have an annual income of $1.5 million dollars - people have done strange things for much less money than that.

Let's hope the second weight loss surgery procedure will bring her what she's looking for.  She's such a beautiful woman and a great singer and somehow all of that tends to get lost in her frantic efforts to get slimmer. To me, that is sad.

Click on this blog link to see photos and story.

Tuesday, January 24, 2012

Dr Oz of TV and his infomercial about gastric bypass

In case you haven't heard by now, Dr Oz on Monday, January 23, had a segment about the gastric bypass surgery for weight loss, touting the invasive procedure as a "miraculous cure" for diabetes and hypertension.

In his opening statement, Dr Oz asked, "What if I told you there was miracle that helps you lose weight, lower your risk of cancer and heart disease and most shocking of all, reverse your type II diabetes overnight?"

Other than the fact that the gastric bypass strains the heart rather than protects the heart (as does any type of invasive surgery), it's interesting to note that the show segment following this rather dramatic announcement, did not mention cancer at all!

The problem with the show is that Dr Oz "forgot" to tell any of the risks of this surgery, which is being done less and less due to the availability of safer options like the lap band which do not call for the surgical dissection of the stomach nor the bypassing of any of the small bowel.

Dr Oz detailed one risk - the fact that patients might regain the weight, but he assured the audience that if patients did what their doctors expected, this would not happen and he emphasized the quick weight loss after surgery, without a reminder that most patients only retain less than 50% of the initial weight loss unless they work very hard at dieting and exercising, two things which will cause weight loss without outdated, risky surgery.

Butch Rosser, a surgeon who recently joined the "gold rush" of weight loss surgery, was also a guest on the show. Rosser had a gastric bypass 3 years ago and has not yet, experienced any repercussions - at least, none that he wanted to talk about on the show.

One of many things which concerned me, was that several things were misrepresented on the show.  For example, Dr Oz stated that the gastric bypass was invented in the 1970's - not true - it was invented in 1965 by Dr Edward Mason, who stopped doing his own surgery in 1980 after he found most of his patients to be suffering from severe osteoporosis and more.  Mason wrote prolifically about the problem of "metabolic bone disease" in gastric bypass patients but unfortunately, only in medical journals - not in places most prospective patients would visit.

Dr Oz also gave the impression that the gastric bypass was not invasive as far as disturbing digestion, reiterating the myth that the food meets the digestive juices lower in the small bowel.  In truth, the bypassed stomach does not produce a lot of acid and when it does, it gets rid of it quickly - since no food in the stomach is how our bodies tell the stomach to release the acid.  What acid there is, is more likely to cause an ulcer in the small bowel than to digest food.  Also the small bowel does not have the protective qualities of the stomach against the acid erosion and it is unknown whether without the presence of food, the duodenum or first section of the small bowel, also bypassed in the gastric bypass, will neutralize the acid released by the stomach as it does in normal digestion.

All this led Dr Mason to write about the disturbances in digestion the gastric bypass causes:

"I would like to see greater use of simple restriction procedures that do not rearrange these finely balanced mechanisms." U of I Healthcare news

So why did Dr Oz so ardently "sell" the gastric bypass (and bypass the more modern procedures which are also safer like the lap band)?

One can only speculate about this - obviously somewhere along the line, there might have been money changing hands - the misrepresentation of facts can usually be traced to the "money trail". Also, less and less people are opting for the gastric bypass which might be leaving some weight loss surgery surgeons in the need to learn new surgeries, a process no one enjoys.

Whatever the case, it was using television and a lot of misrepresentation to hard sell surgery which is, at the least, ethically challenged.

From the patient and other reactions I've heard, Dr Oz lost some fans after this show segment - people are not quite as naiive about these weight loss surgery procedures as he seems to think they are.  One individual wrote me that they had always felt Dr Oz was awesome but after they'd seen this segment on the gastric bypass, they were totally disallusioned with Dr Oz.

And as for Butch Rosser, MD, the gastric bypass surgeon - come lately;  when and if he gets longer term repercussions, will he appear on a TV show to tell about this?  No bets.