LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Roux-en-Y

Considering Gastric Bypass Surgery? This Works Just as Well

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Now that obesity is officially a disease (as declared by the AMA) insurance should more readily cover gastric bypass surgeries like the Roux-en-Y gastric bypass.

Personally, I can’t think of a quicker way to absolutely destroy your long term health than to completely replumb the way your GI tract was designed. I mean heck–what was Mother Nature thinking anyway? We can make your GI tract better (faster, stronger. Cue “Six Million Dollar Man” theme and throw in some of those mechanical cranking sounds that you’d hear when Steve Austin threw an iron beam…).

There is no doubt that people who undergo gastric bypass surgery lose weight. The most common gastric bypass procedure done in the US is the Roux-en-Y bypass, which is derived from the French would Roux, a procedure used by plumbers to redirect water from the shower directly into the toilet.

Interestingly, researchers have had a hard time finding exactly why the Roux-en-Y surgery works so well in the first few months for weight loss. The nasty little secret few surgeons will mention is the increased rate of colon cancer, bone loss, potential need to have a portion of your pancreas removed, high likelihood of nutritional deficiencies and high likelihood of weight regain in 5 years. And the procedure is essentially not reversible–your GI tract is screwed up for the rest of your life.

Most of the theories center around two aspects–GLP-1 production and very low calorie diets. GLP-1 is the “anti-diabetic” hormone that is produced by your small intestine and is the subject of most of the new diabetic research over the past 5-10 years. It may be that, with such a massive change to the GI tract, your body ups the production of GLP-1 in an attempt to expand the GI tract tissues and suck what little nutrients are present out of the calories that you are taking in. This may even be one of the reasons for the increased risk of colon cancer and pancreatic problems in Roux-en-Y surgery patients.

As for the question of calorie restriction, this particular study goes a long way towards addressing this question. Researchers compared a small group of diabetic patients who underwent the Roux-en-Y bypass to a similar group of diabetic patients who spent 21 days on a very low calorie diet that closely mirrored those who had the surgery (500 calories / day). This number may sound familiar–it’s the same amount of calories taken in the HCG / Simeon’s diet protocol as well as the weight loss program that we offer in our office.

For those of you who have already had the surgery, you may want to stop reading here. After 21 days, the weight loss was the same. Further, changes in insulin sensitivity, β-cell function, fasting glucose and fructosamine levels were similar. In other words, the caloric restriction, at least in this study, was the most powerful tool and not the surgery. And, as mentioned, you’re stuck with the surgery.

Some may say that maintaining a 500 calorie per day diet is just too hard. Really?? Compared to having a major gastrointestinal surgery that completely screws up your body’s ability to digest and absorb nutrients?

Either way, the next time you or a friend go to an informational meeting at one of the weight loss centers (i.e. surgical centers) ask the presenter if a very low calorie diet can help instead of surgery. If nothing else, it will be interesting to see how they answer the question.

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.

Read more…

CAN GASTRIC BYPASS SURGERY CAUSE CANCER?

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Gastric banding.  Gastric sleeve.  Roux-en-Y bypass.  There are in increasing number of procedures available that fall under the category of bariatric surgery.  This is also increasing coverage for the procedures by insurance if certain criteria are met.  Roux-en-Y is the most common form of surgery used.  But are these procedures safe?

Let’s get one thing on the table right now.  ANY time you alter digestion, be it with drugs that suppress acid production (Nexium, prilosec, etc..) or with surgery this is a price to be paid.  That price can be severe, with the end consequence being death.

I have mentioned before that the body does two things–digestion, and everything else.  We already know that malabsorption of nutrients leading to nutrient deficiencies occurs. We know that the risk of gallbladder problems goes up.  We know that the bariatric surgery patient’s diet is forever altered.  Far too often, the patient puts the weight back on because they never learned the right way to be eating for their body in the first place.

But what about the short term?  Well, there are rapid positive changes that can occur such as reversal of diabetes and weight loss.  But what about after that?  We’ve already mentioned the long term nutrient deficiencies that will plague the bariatric patient for the REST of their lives.

This particular article begins to shed light on some more severe consequences of the Roux-en-Y bypass surgery.  Elevation of cancer markers in the rectum are known to be present 6 months after the procedure.  This study looked at what happens 3 years later.  Do the markers improve?  Not even close.  There remains, 3 years after the procedure, a 4,000% increase in the tumor marker macrophage migration inhibitory factor in the rectum.

It is still too early to determine what this does to the risk of colorectal cancer.  But, if I were to place my bets, I’d bet that the rates of colorectal cancer in these patients are going to be markedly elevated.  Some much for the short term benefits…

The bottom line is that the right lifestyle changes are always your best answer.  Our office has also had success with our in house weight loss program as well, that helps to educate patients while assisting with initial rapid weight loss.