April 21, 2008

Gastric Bypass Cures and Kills

Yesterday night the TV news show, 60 Minutes, ran a segment promoting the idea that gastric bypass surgery can cure diabetes. Not content with promoting this dangerous surgery to the morbidly obese, surgeons are now recommending it for people who are merely overweight.

This is scary.

Why? Because this surgery kills people. Doctors promote it for the morbidly obese by claiming that their weight will kill them anyway. What they don't point out, is that the surgery can kill them a lot faster than their weight will. Something like 1 in 200 people who have gastric bypass surgery die within six weeks of the surgery.

But what is far more significant is that many more people who have this surgery--including those who lose a lot of weight--die within five years of the surgery.

Unfortunately, the way that surgeons collect data about the success of their surgeries ensures that the public does not learn these statistics. Doctors claim that the surgery is no more dangerous than gall bladder surgery, but this is only true if you look at the statistics collected within a few weeks of the surgery. But unlike gall bladder surgery, once the surgery heals the complications have only begun.

The Junkfood Science blog alertly reported on a study that tracked long term mortality after weight loss surgery. That study is found HERE but the full article is pay only so we have to rely on the blog authors for the details.

What Junkfood Science reports is that this study found this: "We also estimated the long-term mortality for individuals who had undergone surgery many years ago. For the 1995 cohort who had at least 9 years of follow-up, 13.0% had died. From the 1996 cohort with 8 years of follow-up, 15.8% had died, and from the 1997 cohort with 7 years of follow-up, 10.5% had died. For the 1998-1999 cohorts with 5 to 6 years of follow-up, the total mortality was 7.0% to 2004."

Junkfood Science's author then looked at death rates for people with the same demographic who did not have surgery and reports "The U.S. National Center for Health Statistics of the Centers for Disease Control and Prevention data reports that the overall death rates among Americans of the same age is 0.352% — for men it is 0.44% while for women this age it’s 0.26%."

So basically people who had weight loss surgery were dying at a rate many times higher than normal--even the rate normal for obese people.

All this is abstract and statistical until we start putting a face on some of the victims who did not make it into the mortality statistics because their deaths--though caused by the complications of weight loss surgery--took five or more years to occur. One of them turns out to be Claudette Yamin, the much-beloved mother of Elliott Yamin, the American Idol finalist who uses in insulin pump to control his Type 1 diabetes.

Many of us fell in love with "Mama Yamin" as she qvelled with happiness at her son's unexpected success. What we didn't know when we saw her hobbling through the crowds was that she had undergone dozens of operations for the complications of the weight loss surgery she had undergone five years ago and was periodically hospitalized for protein supplementation because she was starving to death. This past month the complications killed her. She died rail thin, at 65 years old, still full of vitality and enthusiasm for life.

She spoke about her complications from weight loss surgery on this television interview: http://www.youtube.com/watch?v=28JEjVK6dnw

As you can see in the interview, Claudette Yamin was told that her anorexia after surgery was an emotional problem. In fact, it probably was not. The incidence of severe psychiatric problems after such surgery is surprisingly high, as documented by Bama Gal in the Back Across the Line blog. Because the surgery changes the functioning of incretin hormones which are known to affect how the brain relates to food, the anorexia that is caused by this surgery is most likely physiological in nature.

I personally have experienced how powerful the manipulation of incretin hormones can be in affecting the hunger response when I became anorexic after two months on Januvia. The anorexia vanished when I stopped taking the drug, but while I did it became harder and harder to eat anything, which for me, food lover that I am, was bizarrely odd. But for the last month while the drug was in my system it was as if food no longer was food, but plastic. Eating became a weird experience as it seemed odd to put this stuff into my body.

Gastric surgery permanently changes how incretin hormones work--which is probably why it can "cure" diabetes in some people, since incretin hormones are deeply involved in the secretion of both insulin and glucagon. But the anorexia when it occurs does NOT go away and as we all know, anorexia kills.

The other way that weight loss surgery kills, long term is by destroying the stomach's ability to absorb nutrients from food. Though some forms of weight loss surgery are supposed to be reversible, this is not always true. Bands can grow into the stomach and cannot be removed. Wounds in the stomach may not heal and may end up destroying stomach tissue permanently. And once the stomach tissue is destroyed, you may fall victim to relentless malnutrition syndromes because your body can no longer absorb nutrients from your food no matter what you eat. Then it is time for visits to the hospital for intravenous supplementation. For the rest of your life.

At that point, the fact that you "cured" your diabetes may be a wry triumph, since you are basically starving to death.

So before you let some knife happy surgeon--who only follows his patients for six weeks after surgery--talk you into what might be a fatal cure for your diabetes, try some of the other strategies that will control your diabetes and help you lose weight without risking your life.

1. Cut the carbs. It appalls me that this dangerous, irreversible weight loss surgery is being promoted as safe by the the same doctors and organizations who continue to warn people with diabetes that "low carb dieting might be dangerous" despite the fact that a decade of research has not yet uncovered any evidence that low carbing does anything but lower blood sugar and improve lipids.

2. UPDATE (April 2, 2013): Before you take Byetta, Victoza, Onglyza, or Januvia please read about the new research that shows that they, and probably all incretin drugs, cause severely abnormal cell growth in the pancreas and precancerous tumors. You'll find that information HERE.

original text: Try Byetta for weight loss. The anorexia induced by Byetta is reversible and it doesn't appear to do anything permanent to your stomach and intestines. For some people it can lead to dramatic weight loss. It is worth a try. For many people with diabetes Byetta is much more effective for hunger control than it is blood sugar control so if you use Byetta, keep an eye on your blood sugars and if they are too high, make sure you have other strategies in place to control the blood sugars while you limit appetite.

3. If you are on insulin, ask your doctor about Symlin. It may also have weight loss benefits for some people.

4. Ask yourself: Is it worth "curing" your diabetes by having a surgery that gives you a 1 in 6 chance of being dead in 10 years? The reality is that it takes 20-30 years of extremely poorly controlled diabetes to kill most people. And if you control your blood sugar which most of us can do very well and keep your A1c in the 5% range you will live much, much longer than that, complication free. Being thin might be nice, but the fact is all of us know obese people who have lived long and productive lives while tipping the scales at 300 lbs for decades. I certainly have. Perhaps there is nothing right now that will get the weight off you, but you can still control your blood sugar, and there is always the possibility that in time some new finding will lead to a medication that will be effective for you.

It's worth staying alive to find out. Even if you have to put some effort into controlling your blood sugars.


Unknown said...

Very interesting subject and a very useful perspective from you. The mortality statistics for gastric bypass surgery are even worse for those on Medicare, perhaps because they're generally older and many are on disability with multiple health problems. Here are results of one recent "meta-analysis" of outcomes from bariatric surgery (similar to what's proposed for diabetes). Mortality is a shockingly high 11% of seniors within the first year after surgery(see below). I presume that diabetics generally would also have poorer surgical outcomes than a non-diabetic population. Bottom line; this phenomenon should result in some useful research follow-up, and may contribute useful information to the mix for those already considering bariatric surgery, but the extremely serious risks of surgery must be put in proper perspective. Here's an excerpt and a link to the study.

"There were a total of 16,155 patients who underwent bariatric procedures. The rates of 30-day, 90-day, and 1-year mortality were 2.0%, 2.8%, and 4.6% respectively. Men had higher rates of early death than women. Mortality rates were greater for those aged 65 years or older compared with younger patients (4,8% vs 1.7% at 30 days, 6.9% vs 2.3% at 90 days, and 11.1% vs 3.9% at 1 year; P <.001)"


Anonymous said...

I saw this show and was horrified as it was pure marketing and filled with misinformation. It is critically, vitally important for people to realize that bypass did not CURE diabetes, it resulted in temporary reductions in blood sugars, an early symptom of rapid weight loss and starvation. They have not shown these surgeries to actually cure diabetes, nor has any post-bypass study lasted long enough to show that. All studies to date show an unfavorable risk-benefit ratio long-term.

Anonymous said...

I have noticed an increase in the number of large ads for bariatric surgery in our local newsrag. The ads usually feature a large photo of an attractive, healthy-looking middle aged woman with a smaller "before" photo, and a brief story about how great her life is, thanks to the surgery. For some reason, reversal of improvement of hypertension is frequently listed as the major medical benefit.

I guess there is a lot of competition among surgical centers for bariatric surgery patients, which makes sense, I guess, being elective. Still, this ad also seems to promote not only choosing the particular center, but also to promote the surgery to those who haven't yet considered it.

Alcinda (Cindy) Moore said...

I watched a couple of clips online and was shocked at the doc that was upset because people that aren't obese can't get approval. He thought having diabetes alone should be enough!!

I am just amazed at this. Last week there was a write up and the people commenting were begging to find out how to qualify! But restricting your carbs is "dangerous".

Anne said...

I was horrified too. This doctor on 60 minutes wants to offer this surgery to people who are not obese so he can cure their diabetes. They said clinical trials have begun in San Paulo on the non-obese diabetics.

Bariatric surgery can result in severe nutrient deficiencies. The obvious ones may be corrected, but what about all the micronutrients that are not absorbed?

Anonymous said...

Jenny - this was timely, well stated, and I hope will be widely disseminated. RobLL

Anonymous said...

I wrote about this episode too, because I was also horrified about the marketing.

Alcinda (Cindy) Moore said...

Anonymous said: "did not CURE diabetes, it resulted in temporary reductions in blood sugars"

I agree. My niece was diagnosed with blood sugars in the 700s. The only symptom she had was vision problems. She's a tad over 300# @ 5'8", early 40s. She stopped drinking regular sodas and dropped to "normal" ranges, so says she no longer has diabetes.

Back when I was in school (RN, 76 grad) we were taught that "once a diabetic, always a diabetic", including gestational! The reason was that if these people weren't careful they would become a "full time" diabetic sooner rather than later. "Diet controlled diabetes" was a recognized diagnosis. But these people were considered diabetic and should be treated as such, which included checking blood sugars, recording weight and intake, and sometimes even covering with insulin. (Illness is stressful and can cause increased blood sugars)

I don't get this. WHY are they so unwilling to name carbohydrates as a major player? They're going to kill people with surgery....and they're already killing people with unnecessary drugs, but still they refuse to see the facts before them!

Jenny said...

I think a huge part of why the medical establishment continues to ignore carbohydrates is that they have been telling people with diabetes to eat lots of carbs for several generations now.

So to face the truth of what they've been doing would mean a lot of doctors would have to accept that they have been giving out advice that worsened their patients' health.

The ADA raises a ton of money from people with diabetes too, and they have been in the forefront of the "Carbs are Good For You" movement. Many of their sponsors are companies that sell carbs. They put their logo on high carb foods, too.

So they too would end up looking bad, and that might cut down on the flow of money that supports their (non-diabetic) executives' enormous salaries.

So they don't mention the C-word and they all feel better. Too bad for the poor schnooks with diabetes.

The ADA's "Tight control" web page that is supposed to be telling people the benefits of good glucose control still does not mention the word "Carbohydrate."

Alcinda (Cindy) Moore said...

The ADA's "Tight control" web page that is supposed to be telling people the benefits of good glucose control still does not mention the word "Carbohydrate."

WOW!!! I just found and read the page on the ADA site! Not only do they not mention the word "Carbohydrate", they pretty much don't even mention diet, other than to say eat less and exercise more!

pinklady1105 said...

I have had severe Type 2 diabetes since I turned 40. Since developing diabetes, I put on 100 lbs. At age 53 I decided to have a gastric bypass. It was the best decision I could have made. I had the surgery with a well-known surgeon and I have had excellent results. The surgery went fine with some pain in the right center abdomen, sort of a feeling like being kicked in that area. I have gone consistently for blood tests and everything is great. I have no mal-absorbtion problems. I do not feel severe hunger, but some hunger. If one follows the post-op diet to the letter, I believe that is the key to success. My diabetes has been in remission ever since 2 weeks after the surgery. From taking 4 glucovance tabs p/day, taking byetta 2x day, taking insulin throughout the day, and taking lantus at bedtime I now take nothing at all. My diabetes is in remission, I do not consider it a cure. But I have to say, I lost weight, I have no mal-absorbtion problems, and my diabetes, high blood pressure are gone. This information is for those who are considering the surgery but who are scared by all of the naysayers. Get an excellent surgeon with great references and a proven track record, and follow the post-op diet to the letter. Remember to eat 6 small meals a day, and to take your vitamins and calcium everyday. Here's hoping those considering this surgery will have the success I have had.

bariatric barbie said...

I don't know where your getting your info dude but you are sadly misinformed. There are tons of crack pot drs doing this surgery. You have to use a reputable surgeon. If the stats were 1-200 drs would be sued left and right for malpractice. This article is subjective opinion.