LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

gastric bypass

GASTRIC BYPASS A HOAX?

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No one reading this blog would, for one nanosecond, believe that I think that any type of bariatric surgery is a good idea.  Sure, there are varying degrees of severity like the LapBand and Roux-en-Y bypass, but they all miss a very, very important point.

 It has even gotten to the point where insurance will pay for a gastric procedure, which ranges anywhere from $18-35,000.  Research on bariatric procedures actually show some pretty good benefits quickly after the procedure.  But this is where it ends.

Most of the long term studies on gastric procedures do not show good long term effects.  Period.  While the long term effects of LapBand do not seem to be as dangerous as bypass, they all have a critical shortfall.  Patients have not learned how to eat right.

Sure, there is a required class to take before insurance will pay for your procedure (yeah–just how effective is a class taught by the people that stand to make thousands of dollars on your procedure??), but these are usually just to subliminally reinforce that your weight is genetic and there is little you can do about it.

This particular study just nails it.  They followed 100 Roux-en-Y patients for 5 years.  At the end of 5 years, a striking 85% had experienced significant weight regain.  The diets had excessive intake of calories, snacks, sweets, and fatty foods.  Furthermore, sedentary lifestyle was common.  Many of these patients did not feel they had adequate nutritional counseling.  Which is extremely disturbing, since, with a bypass surgery, you have permanently altered the ability of your body to break down and absorb nutrients.

The bottom line is that, while many think surgery will be the answer and the bariatric clinics will give you all kinds of emotional stories of how patients got their lives back after surgery, the reality is quite different.  Without making the lifestyle changes that should’ve been done prior to the surgery, the chance for weight regain is high.

COULD ANTIBIOTICS LEAD TO OBESITY?

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There should be no shock to find out just how vitally important having the correct balance of bacteria in our gut is.  The list of conditions that probioitics have shown an effect on is quite a long one.  But this study really looks from a different angle.

The link between bacteria in our gut and obesity is not a newly studied one.  The links between dysbiosis (unhealthy composition of bacteria in our gut) and obesity seems to strengthen with each study.  This particular study goes even further.

Keep in mind that this is a rat study.  The researchers performed a Roux-en-Y gastric bypass on one group and looked at what happened to the rats.  The list is quite long.

First, there was a definate, strong change in the bacteria of the gut.  What this means, we don’t know just yet, but it strongly suggests that there are ties between obesity, bariatric sugery and the bacteria in our gut.  Maybe the changes associated with the surgery, which lead to weight loss, led to the bacterial change.  But does the bacterial change lead to the weight loss?  We don’t have the answer yet, but since it is well established that the metabolic changes that occur after bariatric surgery occur long before weight loss, this may be a logical progression.

It also raises the important question about whether our heavy reliance on both C-sections and antibiotics may not be contributing to the obesity epidemic.  Certainly there are other factors, but we can’t ignore the importance of a healthy gut flora.

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MORE EVIDENCE THAT INSULIN CONTRIBUTES TO DIABETES

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When it comes to hormones, there are levels that are optimal and levels that wreak havoc.  Certainly insulin falls into this category.  This is confirmed by the ACCORD trials, where diabetics used insulin more aggressively, but the trial was stopped because these subjects using aggressive insulin were dying 40% faster.

The problem with diabetes has never been about the insulin.  Certainly our body’s ability to produce insulin from the beta cells of the pancreas is an integral component to the progression of diabetes.  This is why a prediabetic finally tips over into diabetes–because the pancreas can no longer produce the elevated insulin required to compensate for the real problem.

The relationship between the cells and insulin is the most important component of the diabetic / prediabetic process.  Anything that improves that relationship (exercise, wise dietary choices, targeted supplementation) is good and anything that harms (stress, environmental chemicals, poor quality diets) is bad.  While metformin does improve this relationship, it does so ONLY in the liver.  I had a patient come in recently who was put on metformin because it helped insulin do its work in the heart.  This is NOT true and she was mislead.

So…on to this particular study.  This study looked at what happened to diabetics who underwent the Roux-en-Y gastric bypass and found that two important things happened.

First, the diabetes went away based on blood glucose.  Second, insulin levels decreased dramatically.  So, lower insulin = lower blood sugar.  Somewhat opposite of what we normally think, huh?

But, insulin resistance, the situation that created the diabetes in the first place, was unchanged.

A few comments on this.  First, don’t run out and schedule your bypass surgery today to get rid of your diabetes.  We’ve seen studies using a very low calorie diet get insulin dependent diabetics off their insulin in a week.  And the bypass surgery will forever alter your body’s absorption and utilization of nutrients and may increase your risk of colorectal cancer, which the low calorie diet does not do.

Second, without the insulin resistance being fixed through the proper lifestyle changes, it is very possible that this is why studies show a high percentage of patients end up with regain of weight in the following years.

More than anything, though, this shows how powerful the things we put into our mouths can be.  In the case of the bypass surgery, there is no question that the caloric intake is drastically reduced, although many are not educated on the quality of foods to be eaten.  And yet, the affect on glucose handling is, without a doubt, powerful. 

So, do not EVER discount the power of diet to modify our progression to our away from diabetes.  Medications did not achieve this.  While this study used surgery, the outcome can be done without permanently modifying the way your digestive system works.

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