Things to think about when you are considering Weight Loss Surgery

A Gastric Bypass is not only a 'stomach stapling' as the media is fond of calling it. It's also an intestinal bypass. In a proximal bypass (like Carnie Wilson had), only about 20 inches of small intestine is bypassed but that includes the Duodenum in which most of the absorption of vitamins and minerals takes place.

This means that even with a small amount of intestine bypassed, the post op might develop vitamin and mineral deficiencies. Calcium deficiency: The only place the body can take in calcium is in the duodenum part of the small intestine - this is totally bypassed in all gastric bypasses except the 'duodenal switch' (in which 2 inches are left - probably not enough to do any more than absorb some sugar and prevent 'dumping'). This means that no matter how much calcium supplements you take, research has shown that your body might not be able to access it. And this means, you have a strong probability of coming down with osteoporosis sometime after the sixth year post op.

The newest studies show that gastric bypass patients lack a hormone called "Ghrelin" in their bloodstream. This hormone is known to encourage the production of "human growth hormone". The lack of this hormone (and consequently no HGH) in gastric bypass patients may explain the fact that most seem to age greatly after their gastric bypass. HGH is considered the key factor in our aging process - the less we have, the more we age. You will have to supplement other vitamins like B12 and iron for the rest of your life. B12 is best taken in 'shots'. This is because your digestive system no longer digests or absorbs many vitamins and nutriants.

You might have to go back to the hospital for repeat surgeries for hernias, bowel obstruction (this is very painful until you have the surgery done) and scopes (tubes down your throat to see if all if ok). Some WLS post ops also have a lot of plastic surgery because the original surgery does not give them the svelte figure they imagined it would. Gastric bypass patients don't have much appetite because it is difficult to eat and they often are nauscious. Think of eating food when the opening for the food to leave the pouch is very very small. Everything has to be chewed very well. Because if it gets stuck in the opening leading to the small gut, it can cause very intense pain until it dissolves. Occasionally patients have to go to the hospital to get the food removed surgically.

Bad gut bugs: After your stomach is made very small, it will not produce much acid anymore. This is done to save acid from burning your esophagus but the down side is that the bacteria in the food do not get killed and can get into the blood stream. This is called Leaky Gut Syndrome and is suspected to cause autoimmune disorders like LUPUS, rheumatoid arthritis and even in rare cases, multiple sclerosis. Since you may have a lot of bacteria getting into your blood, you might be sick more often after weight loss surgery.

Restrictive diet and exercise: Some people go into surgery because they think the procedure will work automatically. The reality is that after the first year, gastric bypass patients will likely face dieting and exercise to maintain their new physique. The restrictive diet includes no fat, no sugar - much more restrictive than is necessary without surgery! (The "Hebrew Study" showed that 25 % of those patients surveyed, gained back all their weight within 6 years. Only 7 % of those surveyed kept off ALL the weight that they lost)

Some post ops who are four and five years out from surgery, do stay fairly thin but only because they have a lot of physical problems. Be careful that you aren't exchanging one set of problems for another.
Cancer will make you thin also but that doesn't mean it's something a person would want to have.

Weight Loss Surgery will not fix depression. As a matter of fact, prolonged starvation (which you will experience, eating 500-1000 calories a day and not absorbing much in the way of nutriants) has been observed to cause depression.
The reason you start to gain weight after a year or so, is because your body has set your metabolism way down due to the prolonged starvation for the first year. Your body does this by cannibalizing it's own muscles and even parts of organs. There is a growing body of evidence that starvation can cause brain damage and a lessening of mental abilities as well. This would make sense as the brain is not necessary to maintain life. (Some surgeons suggest doing tests to make sure your body is burning muscle and organ parts - instead of fat - so that you get the proper amount of protein in those months after surgery when you are not eating very much... see the Scopinaro study on www.duodenalswitch.com )

According to what statistics are known (although the gastric bypass has been being done for over 40 years, not many long term post ops are to be found), about 1 out of every 200 who has the surgery, dies from complications. There is also some evidence that many deaths during the first year after surgery may be attributed to other causes like 'obesity'. This would possibly make the statistics incorrect i.e. the death rate might be and probably is, much higher than those selling the surgery are willing to admit. Success stories on websites are usually newly post op. All diets have their group of 'camp followers' who are successful with the diet and say its great. Weight Loss surgery (which IS a diet) is no different. But most of the camp followers are less than three years out from surgery.

Some rheumatogists seem to feel that the high prevailence of rheumatoid arthritis, joint disease and the like they see in post op WLS patients IS connected to the surgery. A rare complication also seen a few years after surgery is a partial paralysis, usually of the legs called "neuropathy". B12 deficiency can cause autoimmune disease like LUPUS.
Reversing the procedure: Today's surgeries are meant to be permanent. This is because in most of them, the stomach is partially destroyed. This is why surgeons talk about a "take down" rather than a reversal. A person requiring a takedown usually has a difficult time finding a surgeon to DO one. A person should realize that once they have had the surgery, even with a 'takedown' they will have repercussions for the rest of their lives.
Is Surgery the only way? Will you die without it? Numerous studies of obese people show that if they exercise and eat a reasonably healthy diet, they can remain large and still be healthy. Programs like "Susan Powter" allow for unlimited quantities of many foods and will take anyone's size down to within the so called "average range". If you have a proximal gastric bypass, you will probably begin gaining weight after 12 to 18 months. For this reason, some patients have distal bypasses and BPD (bileopancreatic diversions). In this type of bypass, over 50 percent of the small intestine is bypassed, not that much different from the old (and dangerous) intestinal bypass! If you have this drastic surgery, there is a good chance that you might develop severe nutritional deficiencies due to lack of absorption. Many surgeons will not do distal bypasses and BPDs for this reason. Although they've refined the operation somewhat by closing off the bypassed intestine, there are no guarantees of not having the nasty side effects seen in the older surgeries.

Liver failure: patients are told that the old 'intestinal bypass' is no longer done due to the high incidence of liver failure in patients. However, many post op gastric bypass patients have elevated liver enzymes, a sign of liver damage. There are no guarantees that the gastric bypass won't also cause liver failure long term.

Stomach Cancer: According to medical books, anyone whose stomach is cut open, cut in two or surgically modified (called a 'gastrectomy') is of much higher risk for stomach cancer.

According to the ASBS website: "Any procedure involving malabsorption must be considered at risk to develop at least some of the malabsorptive complications exemplified by JIB (jejuno-ileal bypass). " All gastric bypasses work partially through malabsorption
So the following complications might (according to the ASBS) be seen with the modern gastric bypass:
Listing of jejuno-ileal bypass complications:
Mineral and Electrolyte Imbalance: Decreased serum sodium, potassium, magnesium and bicarbonate. Osteoporosis and osteomalacia secondary to protein depletion, calcium and vitamin D loss, and acidosis,

Protein Calorie Malnutrition: Hair loss, anemia, edema, and vitamin depletion

Enteric Complications: Abdominal distension, irregular diarrhea, increased flatus, pneumatosis intestinalis, colonic pseudo-obstruction, bypass enteropathy, volvulus with mechanical small bowel obstruction.

Extra-intestinal Manifestations: Arthritis, Acute liver failure may occur in the postoperative period, and may lead to death acutely following surgery. Liver disease, occurs in at least 30% Steatosis, "alcoholic" type hepatitis, cirrhosis, occurs in 5%, progresses to cirrhosis and death in 1-2% Erythema Nodosum, non-specific pustular dermatosis Weber-Christian Syndrome

Renal Disease: (in other words, kidney disease and kidney failure) Hyperoxaluria, with oxalate stones or interstitial oxalate deposits, immune complex nephritis, "functional" renal failure.

Miscellaneous: Peripheral neuropathy, pericarditis. pleuritis, hemolytic anemia, neutropenia, and thrombocytopenia.

It should be noted that all surgeries are not equal. A new surgery, the Adjustable Band, has just been approved by the FDA. This is the most often done weight loss surgery in Europe. Although there are not statistics on long term repercussions, this surgery, unlike the others IS reversible as the stomach is not destroyed in any way. The band is not complication free by any means and there is some evidence that it's rather uncomfortable to live with at times, however, the success rates with the adjustable band are similar to those seen with the gastric bypass.