Another study on gastric bypass

Every so often, a new study comes out, presumably "proving" how effective the gastric bypass is.  That's because this surgery is a huge cash cow for the medical field and less and less folks are having it - because of the post op, high complication and death rate (never mentioned in the studies of course). And because at the end of the day, it's not even very effective for weight loss.

This study which appeared in NEJM, was similar to the others.  Sounds very impressive - it was a 12 year observational study they tell us - as the surgery was shown as slightly effective for weight loss and very effective for diabetics.  Let's remember that patients are told if they don't diet and exercise, they won't lose any weight even after an invasive surgery like the gastric bypass but of course, diet and exercise work well without risking one's life to have a gastric bypass, thus the first thing they slip by us, is not distinguishing those who dieted and exercised (which would have caused a weight loss without surgery) from those who didn't.  

If we break down the study, you will see, it's not what it seems to be.  Here's a money quote:

In the study by Adams et al., despite a wide variation in change in body weight across the sample, 360 of 387 patients (93%) in the surgery group maintained at least a 10% weight loss from baseline to year 12, 271 (70%) maintained at least a 20% weight loss, and 155 (40%) maintained at least a 30% weight loss. Only 4 of 387 patients (1%) in the surgery group had regained all their postsurgical weight loss. 

First of all, a 10% weight loss on a 300 lb person is only 30 lbs. But secondly, of course, the high death rate for this surgery (5% in the first month after surgery) is not counted and also even a 30% weight loss is not very impressive. Also, the gastric bypass, more often than not, causes malnutrition which can cause weight loss. (The important parts of the digestive tract are severely undermined or bypassed)  To be fair, they should eliminate all members of the cohort who are suffering from hypoglycemia or malnutrition but of course, they never do that.  

For diabetes, it looks even more impressive:

In the surgery group followed by Adams et al., remission of type 2 diabetes was observed in 66 of 88 patients (75%) at 2 years, in 54 of 87 patients (62%) at 6 years, and in 43 of 84 patients (51%) at 12 years. Of the 62 patients in the surgery group who had initial remission at 2 years and had 12-year follow-up data, 69% remained free of type 2 diabetes at 12 years. Successful remission of type 2 diabetes was strongly predicted by baseline medication status.

But let's look at how they pick the cohort (study participants). Usually, they pick folks who are - what is called - pre diabetic. Which means they don't have diabetes yet, and if and when they come down with diabetes, it's several years before it gets really bad.  Additionally, malnutrition after the gastric bypass helps with this aspect too.  It's well known that starvation or semi starvation will cause diabetes, especially early diabetes, to go into remission.  Bottom line, starvation or semi starvation with a non mutilated digestive tract is safer than that caused by a mutilated digestive tract and causes a better weight loss than invasive outdated surgery.

The study was funded by the diabetes assn and it's a known fact that the funding does influence the results of the study. 

In other words, it's the same old trick - the hope that the public will believe this, rather than do research or question, and rush out to buy the surgery. Because the bottom line is, although they should not even DO this outdated, risky and not real effective surgery anymore, it's a big cash cow.  Buyer beware, especially in a "for profit" medical provider setup.

The Dark Side of the Gastric Sleeve

There are apparently several famous people who got gastric sleeve or sleeve gastrectomy. It looks good. It's not a gastric bypass, so other than undermining protein and fat digestion in the stomach (some surgeons remove 90% of the stomach and put delicately, "send it to pathology"... in other words, discard it), the duodenum which is one of the main digestive organs is left in tact and after all, sleeve gastrectomy is or seems a less risky surgery than gastric bypass et al.

But the gastric sleeve appears to have a darker side. The stomach which is now, about as big as your thumb and twice as long as your thumb, doesn't hold much of anything...for example, patients describe difficulty in drinking liquids and some have observed brown urine from dehydration etc.

Mama June Shannon, mother of the cute little girl who starred on "Here Comes Honey Boo Boo" TV Show, was quite overweight although likely not, the 450 lbs she claimed, had the gastric sleeve.

She said it was an, a lot more painful process than she expected as she also had a couple of skin removal surgeries but on tonight's show, "Mama June, From Not to Hot", she was able to strut her stuff at her ex hubby's "Sugar Bear's" wedding. June was never married to Sugar Bear as she was likely still married to the father of one of her other kids but they made a commitment ceremony last season on Honey Boo Boo's show.

On tonight's show, Mama June, apparently healed from her multiple surgeries, thin and blond, went to her ex's wedding and after, had a fun burning of her old large clothing.  Since June and her daughters have moved into a new rather nice home (TV pays well!), she and friends went out to the middle of the woods for the burning ceremony. However, when she went back home afterward, she suddenly, got very sick. They rushed her to the ER, complaining of severe abdominal pain.  She lived and they promise that next week's show, will feature the entire story of what happened to her. She was in enough pain that she couldn't stand up.

One thing I've seen happen with the sleeve, is a staple line leakage. A patient I know, had to go through multiple surgeries to fix that and included in the dark side of the sleeve, is the fact that unlike the gastric bypass, there is no way to reverse it.

Bottom line, none of these surgeries are really effective because we now know the appetite centers are in the brain...thus surgery or no surgery, we can only lose weight and keep it off by reconfiguring our thinking processes and living in a jungle of high fat, high calorie food, this is never an easy process.  Even Dr Now of the TV show, "My 600 lb Life", admits that surgery is only effective IF the patient diets and exercises...which is, of course, effective without surgery.

So why do they still do weight loss surgery? Because it's a cash cow. The average weight loss surgery surgeon makes $1.5 million bucks a year. People have done strange things for much less than that!

I felt bad for Mama June...she was a happy, reasonably healthy, overweight person and now, she has all sorts of issues with her mutilated digestive tract. 

It's a vicious circle. Providers generally don't follow post ops and complications from all surgeries, are handled by emergency medicine. Overweight people, desperate to lose weight, tend to not do the research they should do, relying on their providers to inform them but without following up on post ops, the providers may not know much more of the long term repercussions than do the patients.

Buyer, beware...be very careful in surgically removing or mutilating the stomach.  That our digestive systems work, wasn't the reason we gained weight and disabling it, is likely to cause more problems than we bargained for.

Thoughts about the TV show "My 600 lb life"

As I watch the TV show, "My 600 lb life", I see many issues .... Elephants in the room, things left unsaid like, the fact that at least 2 of the patients featured on this show, ended up with severe complications such as neuropathy and guillian barre (which the provider attributed to "obesity" even though it was after the gastric bypass that these folks suffered these complications). One  patient uses a wheelchair now (he could walk before his gastric bypass). Another 2 patients that I know of, died a couple of years after surgery which is before they would have died without surgery.  (The bus driver featured in the first or second season, died about two years after his gastric bypass - he had a massive heart attack while driving a school bus.)

First, it seems many of the patients feel the 'before surgery' diet is temporary but in truth, weight loss surgery does NOT fix a damaged metabolism...that is the patient will have to stay on the 1200-1400 calorie diet for life if they want to keep off the weight... it bothers me that many patients don't seem to understand this and so their weight loss after surgery greatly slows down or in some cases, they gain.

Second, with weight loss surgery, there may be a large initial (after surgery) weight loss as the person cannot eat because there is a healing process going on, but after the surgery is healed, the appetite (which is centered in the brain) comes back strongly.

When weight loss surgery was invented in the 1960's, medicine thought the appetite centers were in the stomach and by making the stomach very small, that would control the appetite... Studies and a greater level of knowledge that we have now, have taught us that the appetite centers are in the brain and the size of the stomach makes little to no difference in how hungry most individuals feel... This means that the entire theory upon which weight loss surgery is based, may be outdated.  So one wonders why some providers still do the invasive procedures like gastric bypass?. Well, surgery is a cash cow for providers, unfortunately... and sadly, many patients who have become ill with gastric bypass or have regained, are made to feel ashamed if they speak out.  One of my friends called this a "conspiracy of silence".  She, a weight loss surgery patient herself, died at the young age of 54.  She had been ill with her surgery and bed-bound for several years before her death.

Do providers know that surgery does little to nothing to control the appetite for most folks?  Unclear... They really might think that the surgery helps... To keep up with all the advances in medicine, a provider would have to spend all his or her free time reading...

Most of all, one cannot gain to a very heavy weight, unless one has some serious physical metabolic issues going on.  And no one seems to acknowledge this, although it can be found in medical literature .... And especially not the provider on the TV show, "My 600 lb life"...who assumes that every one of these patients is really stuffing him/herself. However, a revealing study found that members of NAAFA, a fat acceptance group, actually consumed less food at conventions than their thin cohorts!  It's true that people who get very overweight may overeat at times, but basically, most of them eat like many other Americans who do not become extremely obese... And yet these people are made to feel like they are total pigs when it comes to eating. I can't help wondering why providers don't seem to know more about metabolic issues which can cause obesity... 

I stumbled upon my metabolic issue...after spending a lifetime wondering why, if I ate like most around me, I became very overweight... A goodly percentage of folks who had tonsillectomies in the 1950's and 1960's got pituitary damage after surgery... My tonsillectomy was in 1953 and right after surgery, I began putting on weight...That is, before this procedure, I, being very active, was on the slim side, however, after surgery...eating the same amount and with just as much activity as before, I gained weight...

So in digging through medical literature (for years literally), I found the reason why I gain so easily.  Now why don't providers let us know about this, I'm wondering...like those folks on "My 600 lb life", the provider really takes them to task, when they gain weight...

To defend Dr Nowzardan, it's possible he doesn't know about the latest research...he's 72 years old and this may be one reason why people of this age (over 70) should be retired... I am 71 and yes, I do NOT have the brain power I did when I was, even in my 60's, and trust me, it drives me nutz!  To paraphrase Buddy on "Cake Boss" , one might say with emphasis, "It's the aging process, baby!"

Undoubtedly, some of us, like me and those folks on the TV show, "My 600 lb life" have no set point and thus, we can gain easily up to astronomical weights, without especially overeating, at least not more than most Americans who do not gain so easily...

I've tried to explain all this to providers... And most of them naysay what I am telling them. 

Metabolic differences and pituitary damage from procedures like tonsillectomies,  seems  something which, apparently, is not included in the medical school curriculum...

Sue

Weight Loss surgery and dieting

I have heard many folks sign up for weight loss surgery because they feel they will "never have to diet again".  The next step is they go to a "seminar" held by the surgeon they are thinking of hiring. But the seminars are really mostly selling sessions for the surgery (I can only think of one surgeon who actually gives very informed consent seminars, detailing risks as well as benefits - this does not cut the number of people who go to him - on the contrary, they appreciate the info!).

Today, I met a lady who had had a gastric bypass in Oct 2015 and had recently attended a weight loss group meeting. (and keep in mind, most surgeons are doing the less invasive sleeve now).  She had lost 80 lbs but lamented that no one had noticed her weight loss.  "But I lost it fast," she added.  That prompted me to ask her how and that's when she said she'd had a gastric bypass.  I explained that a fast weight loss like that was mostly muscle and that's why it didn't show a lot of reduction in size.  She looked sad and said that she knew that.  She was NOT told that surgery would not take off that much fat and she'd have to diet to do that - and she'd already been back to the hospital because she had developed ulcers after surgery and couldn't keep anything down so had needed more surgery.   I can't help wondering if, had this lady been informed of the risks, she might have gone a different route.

But the sad thing was she really didn't lose much fat with the surgery despite her inability to eat much and ended up joining the weight loss group, even - with having had the surgery.

I gave her my web site and also, some of the informed consent info she should have had before surgery.  "The advantage of a gastric bypass", I concluded, "is, it is reversible and you should probably consider having it reversed."  She told me her surgeon had told her only the sleeve was reversible (it's not reversible, because they cut off most of your stomach and throw it in the garbage i.e. "send it to pathology" as the surgeons call it). I said, "no, it's the opposite - the gastric bypass is reversible" and I told her how they reversed it., explaining that a reversal would still provide her with some restriction but give her normal digestion back.  Hopefully she will consider having it reversed.  I told her she might have to go to another surgeon to have this done.

Some surgeons send pre ops to my website to obtain informed consent information but obviously this lady's surgeon had neither given her informed consent info nor did he send her to my website.  Because the 80 lbs she lost was mostly muscle, she still was very overweight.

The bottom line with surgery is, it really, isn't that effective for weight loss.  This lady told me she thought it would kill her appetite but it hadn't done this and I explained that this is because they now know, the appetite control center is in the brain, not the stomach (as formerly thought in the 1960's when these surgeries were first conceived of).

As for the gastric bypass, it's very effective at greatly diminishing the ability to digest proteins and fats (and yes, we do need some fats) which is why most surgeons have switched to the sleeve which, albeit invasive, is much less invasive than the older surgeries.

Another interesting thing - when I told this lady who had had the gastric bypass that I knew several 300 lbs gastric bypass patients, she looked shocked - she didn't know that so many had regained the weight, although she was already having trouble with this.

All I can do here is *sigh*.  How I wish everyone would have the informed consent information that they need to really make the best decision for them.  Informed consent after the fact, can be bitter but this lady had several friends, also of size and I'm sure my information helped them in case they were considering surgery.... (the photo is of my friend who died in 2006 from the aftermath of the weight loss surgery she'd had in the 1990's. - she spent her last days, before her untimely death, warning folks to not have weight loss surgery.)

Gastric bypass on TLC TV show

My dearest friend in life, Trish, who died way too early, from complications of a WLS she had had several years previous.  I still miss her and this blog is dedicated to her.

 

The Long Island Medium is a show on TLC about a lady who supposedly talks to dead people. The following article is not arguing whether or not she really is contacting the dead but rather that this week's show was mostly dedicated to a mother of a gastric bypass patient who died after his surgery... Following are the highlights:

Theresa Caputo, who is the "Long Island Medium" was doing a group reading at a restaurant.

She hesitated for a moment and then asked one of her general questions which tend to encourage people to tell her about their deaths in the family etc.

Theresa said "I want to talk about the young man who passed in a tragedy."

A woman in the back of the room, raised her hand quickly.

Theresa, facing her, said, " Your son has been gone for some time..."

The woman whose name is Elaine, answered: "Eleven years."

Continuing, Elaine added: "LJ was my only child - I waited a lifetime for him - now that he's gone, a piece of me is gone."

Therese, pausing for a moment, said: "Your son says it was difficult for you, his mother, because it was a total freaky thing."  (in retrospect - this was something she probably said because the son had passed from complications of WLS - as sort of a disclaimer. Like all reality shows, I'm sure this show is somewhat scripted and it has been written that Theresa Caputo spends some time with each person to be "read" on the show, before taping the show.)

Elaine described her son as a football star in college, admitting she had saved his jerseys from his participation in the sport.

Elaine then continued with: "I never expected LJ to die...LJ was 6'1" and 443 lbs... he had gastric bypass surgery. Obviously there's a risk with any surgery
but LJ's surgery was supposed to be 'textbook' and after the surgery, he seemed to be ok but then a month later, he started having complications..."

The complications put him back in the hospital and soon he required the necessity of life support machines.  Elaine did not specify what the complications were but the attending physicians all stated they were a result of his gastric bypass surgery.

In July, a month after LJ's surgery, his mother had to make the difficult decision to turn off the life support machines and even now, 11 years later, she said, weeping,  that there isn't a day, every day, that she doesn't re-live that moment.

" I go through it every day... he passed away from complications - it was sepsis" Elaine said adding that
"I kissed his eyes, his hands and his feet.", after he had died.

When the doctor broke the bad news that their son was in cardiac arrest to Elaine and her husband, her husband had a heart attack on the spot.  Although he survived that heart attack, he died 18 months later.

Theresa described Elaine as having a shattered soul...and Elaine agreed with her.

Bottom line, no one really talks about the relatives, the family of gastric bypass patients who pass on, but from the few I've met, they seem broken up about it for years after the fact... perhaps because weight loss surgery is an elective surgery and often their adult progeny are healthy before surgery albeit overweight, (in this case, the son was a star athlete).  Watching a kid die has been said to be the worst thing a parent can witness.

This particular show can probably be seen on Netflix or even somewhere on the web - or wait for the re-runs.  (photo is the blog author in 2009 trying to ask a WLS provider at a Women's Expo about complications of WLS and getting nowhere!)

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.

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