Study – Alcohol abuse after gastric bypass – 1 in 5

ONE IN FIVE.  ONE. IN. FIVE.

http://www.soard.org/article/S1550-7289(17)30152-1/fulltext

One in five patients who undergo one of the most popular weight-loss surgical procedures is likely to develop problems with alcohol, with symptoms sometimes not appearing until years after their surgery, according to one of the largest, longest-running studies of adults who got weight-loss surgery.

The finding — reported online today in Surgery for Obesity and Related Diseases, the journal of the American Society for Metabolic and Bariatric Surgery — indicates that bariatric surgery patients should receive long-term clinical follow-up to monitor for and treat alcohol use disorder, which includes alcohol abuse and dependence.

"We knew there was an increase in the number of people experiencing problems with alcohol within the first two years of surgery, but we didn't expect the number of affected patients to continue to grow throughout seven years of follow-up," said lead author Wendy C. King, Ph.D., associate professor of epidemiology at the University of Pittsburgh Graduate School of Public Health. She and her team discovered that 20.8 percent of participants developed symptoms of alcohol use disorder within five years of Roux-en-Y gastric bypass (RYGB). In contrast, only 11.3 percent of patients who underwent gastric banding reported problem alcohol use.

Starting in 2006, King and her colleagues followed more than 2,000 patients participating in the National Institutes of Health-funded Longitudinal Assessment of Bariatric Surgery-2 (LABS-2), a prospective observational study of patients undergoing weight-loss surgery at one of 10 hospitals across the United States.

RYGB, a surgical procedure that significantly reduces the size of the stomach and changes connections with the small intestine, was the most popular procedure, with 1,481 participants receiving it. The majority of the remaining participants, 522 people, had a less invasive procedure — laparoscopic adjustable gastric banding — where the surgeon inserts an adjustable band around the patient's stomach, lessening the amount of food the stomach can hold. That procedure has become less popular in recent years because it doesn't result in as much weight loss as RYGB.

Both groups of patients increased their alcohol consumption over the seven years of the study; however, there was only an increase in the prevalence of alcohol use disorder symptoms, as measured by the Alcohol Use Disorders Identification Test, following RYGB. Among patients without alcohol problems in the year prior to surgery, RYGB patients had more than double the risk of developing alcohol problems over seven years compared to those who had gastric banding.

"Because alcohol problems may not appear for several years, it is important that doctors routinely ask patients with a history of bariatric surgery about their alcohol consumption and whether they are experiencing symptoms of alcohol use disorder, and are prepared to refer them to treatment," said King.

The American Society for Metabolic and Bariatric Surgery currently recommends that patients be screened for alcohol use disorder before surgery and be made aware of the risk of developing the disorder after surgery. Additionally, the society recommends that high-risk groups be advised to eliminate alcohol consumption following RYGB. However, given the data, King suggests that those who undergo RYGB are a high-risk group, due to the surgery alone.

The LABS-2 study was not designed to determine the reason for the difference in risk of alcohol use disorder between surgical procedures, but previous studies indicate that, compared with banding, RYGB is associated with higher and quicker elevation of alcohol in the blood. Additionally, some animal studies suggest that RYGB may increases alcohol reward sensitivity via changes in genetic expression and the hormone system affecting the areas of the brain associated with reward.

In addition to RYGB, the LABS-2 study identified several personal characteristics that put patients at increased risk for developing problems with alcohol, including being male and younger, and having less of a social support system. Getting divorced, a worsening in mental health post-surgery and increasing alcohol consumption to at least twice a week also were associated with a higher risk of alcohol use disorder symptoms.

King and her team found that although RYGB patients were nearly four times as likely to report having received substance use disorder treatment compared with banding patients, relatively few study participants reported such treatment. Overall, 3.5 percent of RYGB patients reported getting substance use disorder treatment, far less than the 21 percent of patients reporting alcohol problems.

"This indicates that treatment programs are underutilized by bariatric surgery patients with alcohol problems," said King. "That's particularly troubling given the availability of effective treatments."


Story Source:

Materials provided by University of Pittsburgh Schools of the Health Sciences. Note: Content may be edited for style and length.


Journal Reference:

  1. Wendy C. King, Jia-Yuh Chen, Anita P. Courcoulas, Gregory F. Dakin, Scott G. Engel, David R. Flum, Marcelo W. Hinojosa, Melissa A. Kalarchian, Samer G. Mattar, James E. Mitchell, Alfons Pomp, Walter J. Pories, Kristine J. Steffen, Gretchen E. White, Bruce M. Wolfe, Susan Z. Yanovski. Alcohol and other substance use after bariatric surgery: prospective evidence from a U.S. multicenter cohort study. Surgery for Obesity and Related Diseases, 2017; DOI: 10.1016/j.soard.2017.03.021

Before You Spend $26,000 on Weight-Loss Surgery, Do This – What?

Agreed.

It was the first thing we all did BEFORE weight loss surgery 13 – 15 years ago ANYWAY. Because, it works.



The problem *is* the flipping ________ is addictive and NOBODY GETS THAT PART OF THE EQUATION, and until THAT is figured out?

THE ANSWER IS WEIGHT LOSS SURGERY.

New York Times Op –

Before You Spend $26,000 on Weight-Loss Surgery, Do This

Download Before You Spend $26,000 on Weight-Loss Surgery, Do This – The New York Times

Earlier this year, the Food and Drug Administration approved a new weight-loss procedure in which a thin tube, implanted in the stomach, ejects food from the body before all the calories can be absorbed.

Some have called it “medically sanctioned bulimia,” and it is the latest in a desperate search for new ways to stem the rising tides of obesity and Type 2 diabetes. Roughly one-third of adult Americans are now obese; two-thirds are overweight; and diabetes afflicts some 29 million. Another 86 million Americans have a condition called pre-diabetes. None of the proposed solutions have made a dent in these epidemics.

Recently, 45 international medical and scientific societies, including the American Diabetes Association, called for bariatric surgery to become a standard option for diabetes treatment. The procedure, until now seen as a last resort, involves stapling, binding or removing part of the stomach to help people shed weight. It costs $11,500 to $26,000, which many insurance plans won’t pay and which doesn’t include the costs of office visits for maintenance or postoperative complications. And up to 17 percent of patients will have complications, which can include nutrient deficiencies, infections and intestinal blockages.

It is nonsensical that we’re expected to prescribe these techniques to our patients while the medical guidelines don’t include another better, safer and far cheaper method: a diet low in carbohydrates.

Once a fad diet, the safety and efficacy of the low-carb diet have now been verified in more than 40 clinical trials on thousands of subjects. Given that the government projects that one in three Americans (and one in two of those of Hispanic origin) will be given a diagnosis of diabetes by 2050, it’s time to give this diet a closer look.

When someone has diabetes, he can no longer produce sufficient insulin to process glucose (sugar) in the blood. To lower glucose levels, diabetics need to increase insulin, either by taking medication that increases their own endogenous production or by injecting insulin directly. A patient with diabetes can be on four or five different medications to control blood glucose, with an annual price tag of thousands of dollars.

Yet there’s another, more effective way to lower glucose levels: Eat less of it.

Glucose is the breakdown product of carbohydrates, which are found principally in wheat, rice, corn, potatoes, fruit and sugars. Restricting these foods keeps blood glucose low. Moreover, replacing those carbohydrates with healthy protein and fats, the most naturally satiating of foods, often eliminates hunger. People can lose weight without starving themselves, or even counting calories.

Most doctors — and the diabetes associations — portray diabetes as an incurable disease, presaging a steady decline that may include kidney failure, amputations and blindness, as well as life-threatening heart attacks and stroke. Yet the literature on low-carbohydrate intervention for diabetes tells another story. For instance, a two-week study of 10 obese patients with Type 2 diabetes found that their glucose levels normalized and insulin sensitivity was improved by 75 percent after they went on a low-carb diet.

At our obesity clinics, we’ve seen hundreds of patients who, after cutting down on carbohydrates, lose weight and get off their medications. One patient in his 50s was a brick worker so impaired by diabetes that he had retired from his job. He came to see one of us last winter, 100 pounds overweight and panicking. He’d been taking insulin prescribed by a doctor who said he would need to take it for the rest of his life. Yet even with insurance coverage, his drugs cost hundreds of dollars a month, which he knew he couldn’t afford, any more than he could bariatric surgery.

Instead, we advised him to stop eating most of his meals out of boxes packed with processed flour and grains, replacing them with meat, eggs, nuts and even butter. Within five months, his blood-sugar levels had normalized, and he was back to working part-time. Today, he no longer needs to take insulin.

Another patient, in her 60s, had been suffering from Type 2 diabetes for 12 years. She lost 35 pounds in a year on a low-carb diet, and was able to stop taking her three medications, which included more than 100 units of insulin daily.

One small trial found that 44 percent of low-carb dieters were able to stop taking one or more diabetes medications after only a few months, compared with 11 percent of a control group following a moderate-carb, lower-fat, calorie-restricted diet. A similarly small trial reported those numbers as 31 percent versus 0 percent. And in these as well as another, larger, trial, hemoglobin A1C, which is the primary marker for a diabetes diagnosis, improved significantly more on the low-carb diet than on a low-fat or low-calorie diet. Of course, the results are dependent on patients’ ability to adhere to low-carb diets, which is why some studies have shown that the positive effects weaken over time.

A low-carbohydrate diet was in fact standard treatment for diabetes throughout most of the 20th century, when the condition was recognized as one in which “the normal utilization of carbohydrate is impaired,” according to a 1923 medical text. When pharmaceutical insulin became available in 1922, the advice changed, allowing moderate amounts of carbohydrates in the diet.

Yet in the late 1970s, several organizations, including the Department of Agriculture and the diabetes association, began recommending a high-carb, low-fat diet, in line with the then growing (yet now refuted) concern that dietary fat causes coronary artery disease. That advice has continued for people with diabetes despite more than a dozen peer-reviewed clinical trials over the past 15 years showing that a diet low in carbohydrates is more effective than one low in fat for reducing both blood sugar and most cardiovascular risk factors.

The diabetes association has yet to acknowledge this sizable body of scientific evidence. Its current guidelines find “no conclusive evidence” to recommend a specific carbohydrate limit. The organization even tells people with diabetes to maintain carbohydrate consumption, so that patients on insulin don’t see their blood sugar fall too low. That condition, known as hypoglycemia, is indeed dangerous, yet it can better be avoided by restricting carbs and eliminating the need for excess insulin in the first place. Encouraging patients with diabetes to eat a high-carb diet is effectively a prescription for ensuring a lifelong dependence on medication.

At the annual diabetes association convention in New Orleans this summer, there wasn’t a single prominent reference to low-carb treatment among the hundreds of lectures and posters publicizing cutting-edge research. Instead, we saw scores of presentations on expensive medications for blood sugar, obesity and liver problems, as well as new medical procedures, including that stomach-draining system, temptingly named AspireAssist, and another involving “mucosal resurfacing” of the digestive tract by burning the inside of the duodenum with a hot balloon.

We owe our patients with diabetes more than a lifetime of insulin injections and risky surgical procedures. To combat diabetes and spare a great deal of suffering, as well as the $322 billion in diabetes-related costs incurred by the nation each year, doctors should follow a version of that timeworn advice against doing unnecessary harm — and counsel their patients to first, do low carbs.

Sarah Hallberg is medical director of the weight loss program at Indiana University Health Arnett, adjunct professor at the school of medicine, director of the Nutrition Coalition and medical director of a start-up developing nutrition-based medical interventions. Osama Hamdy is the medical director of the obesity and inpatient diabetes programs at the Joslin Diabetes Center at Harvard Medical School. A version of this op-ed appears in print on September 11, 2016, on page SR1 of the New York edition with the headline: The Old-Fashioned Way to Treat Diabetes.


Permitters and Restrictors.

 

Nobody wants to hear it.

"There is no risk-free level of alcohol consumption," says Dr. Rehm. "There is always some risk, and the risk increases in accordance with the level of consumption."

Having said that, Dr. Rehm believes that it would be helpful to have low-risk drinking guidelines, written for the public, so that people who are going to drink anyway would know how much alcohol would increase their risk substantially. Such guidelines should recognize lower drinking limits for women and advise against episodes of heavy drinking.

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#thebiggestloser – Rachel at the Live Finale – Too far? A post for the WLS community.

As a disclaimer, I have always watched The Biggest Loser casually as someone might watch The Super Bowl for the commercials. I enjoy making digs at the product placement, the commercials, etc. This pleases me #broughttoyoubyziploc #subway #extragum #whomever

This year, however I was taken in a little more, sucked in, even after saying things like:  “I’d never watch that crap,” and “How dare they publicize weight loss competitions!”  I am sure I have said MANY choice things over the years about this (…and other shows) as an online weight-loss blogger, even as product pitches aligned with this show were tossed my way.  I still watch for the product placements.  I also watch for the exercise — WHAT?!

This year, I started a (…word warning) “journey” nine years after I started my massive weight loss path.

I began exercising in earnest.   I dropped some lbs and gained muscle.  I have endurance!

I found that The Biggest Loser gave me some “Actual Motivation” if only for ideas of What To Do To Move My Butt.   It’s the reason I tried the “Jacob’s Ladder,” guys.

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Or, even just for a frame of reference in body-size for someone like me: a former morbidly obese individual whom had been 320 lbs now 144-150 lbs and maintaining my bodyweight while learning to create health, and gain muscle and make exercise a habit.  If you have not been living in a 200, 300, 400 lb body – you must know – the body dysmorphia that comes along with the change from your super-morbid or morbidly obese self to your “normal” self can last for years.  It may not be until you see another person whom is “wearing” your “body” size when you realize what you look like, and only sort of.

That said — The Biggest Loser’s winner, Rachel.  And please remember that I can only relate to what I know to be true, and to what I see in relation to the hundreds of women (… and some men) I read about daily in my weight loss groups for bariatric surgery.  

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She went too far, and sometimes that happens.  

I hope that it was simply because she was pushed to far for the “trigger” of money — and will find balance in health. 

It happens in our bariatric-post operative patients all the time, and the thing is:  bariatric patients don’t have the temptation of a quarter million dollars hanging over their head like a dangling carrot as thin-spiration.  It takes a lot less sometimes for a person to be triggered to lose too far.  Some women (…and men) are pushed by a bad photo, cruel word, or emotional disturbances. 

In the weight loss surgery world, we have a hard time with talking about weight.  We don’t like to talk about “how much weight is too much to lose.”  We don’t like to discuss “too far,” and we say things like “well, you called her fat, now she’s too thin and you hate her for it.”

No.  It’s not that.  You/we really have to stop thinking that way.  It is just the same as having bariatric surgery WAS for YOU.  It was supposed to be about your health and saving your life.  There is not a stitch of hate in the words.  It is out of concern for the person, and the people watching:  like our daughters and sons.  

Going on The Biggest Loser was about stopping this person’s journey through morbid obesity and saving her life, and getting healthy again.  However, dropping to an underweight body-weight and publicizing this for all of us on TV and creating this huge social media #thinspo out of it — is WRONG.

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Where were the trainers, Biggest Loser Team, producers, etc. when she hit the red flags?  Where was the psych team?  Where is her help?  Is this really just about prize money and not health?

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I think that says it all.

You failed, @thebiggestloser

 




Dietary Supplements cause 20% of liver injury

The terrifying issue about diet supplements and liver failure — is that those of us who have bariatric surgery are already at a slightly higher risk for liver concerns.   (Go ahead and look it up.)

Some bariatric patients have a history of fatty liver disease, had WLS to help it, and unknowingly make themselves sick again by taking in high levels of toxins!

It's not just diet pills — you can kill your liver with too much alcohol — acetaminophen — but this is scary guys.

Save your liver.  Please.

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Muscles and meth: Drug analog identified in ‘craze’ workout supplement

Muscles and meth: Drug analog identified in 'craze' workout supplement.

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"In recent years banned and untested drugs have been found in hundreds of dietary supplements. We began our study of Craze after several athletes failed urine drug tests because of a new methamphetamine analog," said lead author Dr. Pieter Cohen, of Harvard Medical School, U.S.A.  A workout supplement marketed as a 'performance fuel', Craze is manufactured by Driven Sports, Inc. It is sold in stores across the United States and internationally via body supplement websites.  The supplement is labeled as containing the compound N,N-diethyl-phenylethylamine (N,N-DEPEA), claiming it is derived from endangered dendrobium orchids. However, while there is no proof that this compound is found within orchids, it is also structurally similar to the methamphetamine analog N,α-diethylphenylethylamine (N,α-DEPEA), a banned substance.

And be warned, variations of phenylethlamine are in EVERYTHING.  READ YOUR PRODUCT LABELS NOW.

RNY patients after gastric bypass surgery have lower brain-hedonic responses to food than after gastric banding

RNY patients lose more than gastric band patients, and this study hypothesizes that RNY patients "think" differently about food.

As a ten-year RNY patient – I scream – AYE!  FOR THE LOVE OF DOG DO NOT FEED ME ICE CREAM!

It's called DUMPING SYNDROME, our brains learn to connect certain foods to the reactions they might or will cause, which is a learned behavior, and our brains react, which can be SEEN on an MRI machine.  Twitch.  Twitch.  (And, no, many people never ever learn.)

Amazing.

Study –

Objectives Roux-en-Y gastric bypass (RYGB) has greater efficacy for weight loss in obese patients than gastric banding (BAND) surgery. We hypothesise that this may result from different effects on food hedonics via physiological changes secondary to distinct gut anatomy manipulations.

Design We used functional MRI, eating behaviour and hormonal phenotyping to compare body mass index (BMI)-matched unoperated controls and patients after RYGB and BAND surgery for obesity.

Results Obese patients after RYGB had lower brain-hedonic responses to food than patients after BAND surgery. RYGB patients had lower activation than BAND patients in brain reward systems, particularly to high-calorie foods, including the orbitofrontal cortex, amygdala, caudate nucleus, nucleus accumbens and hippocampus. This was associated with lower palatability and appeal of high-calorie foods and healthier eating behaviour, including less fat intake, in RYGB compared with BAND patients and/or BMI-matched unoperated controls. These differences were not explicable by differences in hunger or psychological traits between the surgical groups, but anorexigenic plasma gut hormones (GLP-1 and PYY), plasma bile acids and symptoms of dumping syndrome were increased in RYGB patients.

Conclusions The identification of these differences in food hedonic responses as a result of altered gut anatomy/physiology provides a novel explanation for the more favourable long-term weight loss seen after RYGB than after BAND surgery, highlighting the importance of the gut–brain axis in the control of reward-based eating behaviour.