Food intolerances two years after gastric bypass (PS – No, really?)

Apparently this concern with gastric bypass patients hasn't been "well-studied."

Hey researchers – PLEASE SEEK OUT PATIENTS WHOM COMPLAIN OF EXACTLY THESE ISSUES FROM DAY ONE.  

Because, uh, *putting on my Dr. Google Hat* they're totally normal and expected, or so we thought?  Or am I living under a rock where it's that we're not supposed to live with digestive distress most of the time?I suppose this is my bias because I live as a distressed patient, with a distressed patient, and know mostly only distressed patients?  And WHAT IS GOING ON WITH THE FOODS LISTED IN THIS STUDY!?

I am using a lot of question marks lately.  I need to stop that.

Discuss.

Study blurb via Reuters –

(Reuters Health) – A common weight loss surgery is associated with long-term gastrointestinal problems and food intolerance, a recent study suggests.

Researchers examined data on 249 extremely obese patients who had what’s known as laparoscopic Roux-en-Y gastric bypass, which reduces the stomach to a small pouch about the size of an egg.

Two years after surgery, these patients had lost about 31 percent of their total body weight on average. But compared to the control group of 295 obese people who didn’t have operations, the gastric bypass patients were far more likely to experience indigestion and an inability to tolerate multiple foods.

“It was already known from previous studies that the Roux-en-Y gastric bypass might aggravate gastrointestinal symptoms after surgery,” said lead study author Dr. Thomas Boerlage of MC Slotervaart in Amsterdam.

 

 

Study – Weight-Loss Surgery Linked To Increased Suicide Risk

Another OBVIOUS. 

Reuters –

“These findings suggest that more effort may be needed to improve access to mental health care services in these patients should they need them, and perhaps some screening in the second year and onwards,” Bhatti said. 

During the first three years after surgery, 111 patients received emergency care for self-inflicted injuries, or roughly 1 percent of people in the study. While small, the risk of these emergencies was 54 percent higher after surgery than it was before.

Study – JAMA

Importance  Self-harm behaviors, including suicidal ideation and past suicide attempts, are frequent in bariatric surgery candidates. It is unclear, however, whether these behaviors are mitigated or aggravated by surgery.

Objective  To compare the risk of self-harm behaviors before and after bariatric surgery.

Design, Setting, and Participants  In this population-based, self-matched, longitudinal cohort analysis, we studied 8815 adults from Ontario, Canada, who underwent bariatric surgery between April 1, 2006, and March 31, 2011. Follow-up for each patient was 3 years prior to surgery and 3 years after surgery.

Main Outcomes and Measures  Self-harm emergencies 3 years before and after surgery.

Results  The cohort included 8815 patients of whom 7176 (81.4%) were women, 7063 (80.1%) were 35 years or older, and 8681 (98.5%) were treated with gastric bypass. A total of 111 patients had 158 self-harm emergencies during follow-up. Overall, self-harm emergencies significantly increased after surgery (3.63 per 1000 patient-years) compared with before surgery (2.33 per 1000 patient-years), equaling a rate ratio (RR) of 1.54 (95% CI, 1.03-2.30; P = .007). Self-harm emergencies after surgery were higher than before surgery among patients older than 35 years (RR, 1.76; 95% CI, 1.05-2.94; P = .03), those with a low-income status (RR, 2.09; 95% CI, 1.20-3.65; P = .01), and those living in rural areas (RR, 6.49; 95% CI, 1.42-29.63; P= .02). The most common self-harm mechanism was an intentional overdose (115 [72.8%]). A total of 147 events (93.0%) occurred in patients diagnosed as having a mental health disorder during the 5 years before the surgery.

Conclusions and Relevance  In this study, the risk of self-harm emergencies increased after bariatric surgery, underscoring the need for screening for suicide risk during follow-up.




Link – http://archsurg.jamanetwork.com/article.aspx?articleid=2448916

Alcohol Sensitizes Brain Response to Food Aromas and Increases Food Intake in Women, Research Shows

Something I feel like we already knew?  Sigh.  Please read.

PR from The Obesity Society –

Alcohol Sensitizes Brain Response to Food Aromas and Increases Food Intake in Women, Research Shows

First study of its kind ties hypothalamus, in addition to the gut, to the aperitif phenomenon

SILVER SPRING, MD – The first study of its kind measuring the brain's role in mediating caloric intake following alcohol consumption among women shows that alcohol exposure sensitizes the brain's response to food aromas and increases caloric intake. The research, led by William J. A. Eiler II, PhD, of the Indiana University School of Medicine's Departments of Medicine and Neurology, adds to the current body of knowledge that alcohol increases food intake, also known as the "aperitif effect," but shows this increased intake does not rely entirely on the oral ingestion of alcohol and its absorption through the gut. The study is published in the July issue of the journal Obesity published by The Obesity Society (TOS).

"The brain, absent contributions from the gut, can play a vital role in regulating food intake. Our study found that alcohol exposure can both increase the brain's sensitivity to external food cues, like aromas, and result in greater food consumption," said Dr. Eiler. "Many alcoholic beverages already include empty calories, and when you combine those calories with the aperitif effect, it can lead to energy imbalance and possibly weight gain."

Researchers conducted the study in 35 non-vegetarian, non-smoking women at a healthy weight. To test the direct effects of alcohol on the brain, researchers circumvented the digestive system by exposing each participant to intravenously administered alcohol at one study visit and then to a placebo (saline) on another study visit, prior to eating. Participants were observed, and brain responses to food and non-food aromas were measured using blood oxygenation level dependent (BOLD) response via fMRI scans. After imaging, participants were offered a lunch choice between pasta with Italian meat sauce and beef and noodles. 

When participants received intravenous alcohol, they ate more food at lunch, on average, compared to when they were given the placebo. However, there were individual differences, with one-third of participants eating less after alcohol exposure when compared to the placebo exposure. In addition to changes in consumption, the area of the brain responsible for certain metabolic processes, thehypothalamus, also responded more to food odors, compared to non-food odors, after alcohol infusion vs. saline. The researchers concluded that the hypothalamus may therefore play a role in mediating the impact of alcohol exposure on our sensitivity to food cues, contributing to the aperitif phenomenon.

 "This research helps us to further understand the neural pathways involved in the relationship between food consumption and alcohol," said Martin Binks, PhD, FTOS, TOS Secretary Treasurer and Associate Professor of Nutrition Sciences at Texas Tech University. "Often, the relationship between alcohol on eating is oversimplified; this study unveils a potentially more complex process in need of further study."

Study authors agree and call for further research into the mechanism by which the hypothalamus affects food reward.

"Today, nearly two-thirds of adults in the U.S. consume alcohol, with wine consumption rising, which reinforces the need to better understand how alcohol can contribute to overeating," continued Dr. Binks.

Read the full article in Obesity here.

100341

New Treadmill Stress Test Spits Out Your Risk Of Dying

New Treadmill Stress Test Spits Out Your Risk Of Dying.  Hooray. 

 

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If there were any means to get my ass back to the gym and motivated it is reading things like THIS  and pushing through back pain and tearing up my stupid excuses.  BLAH BLAH BLAH BETH, I DON'T CARE THAT YOU CAN'T DRIVE YOU WILL WALK TO THE GYM AND DO IT …

The FIT Treadmill Score is calculated using the patient’s age, gender, fitness level measured by METs, and peak heart rate reached during exercise. Researchers found these four factors to be the greatest predictors of mortality risk. After the research team accounted for other important variables, such as diabetes and family history of premature deaths, they determined fitness level to be the single most important predictor of death and survival.

“The notion that being in good physical shape portends lower death risk is by no means new, but we wanted to quantify that risk precisely by age, gender, and fitness level, and do so with an elegantly simple equation that requires no additional fancy testing beyond the standard stress test,” said Dr. Haitham Ahmed, a cardiology fellow at the Johns Hopkins University School of Medicine.

FIT Treadmill Scores ranged from negative 200 to positive 200 — participants over 0 had a lower mortality risk while participants under 0 has a higher mortality risk. Participants with a score between negative 100 and 0 had an 11 percent risk for dying in the next 10 years compared to three percent among participants with a scare between 0 and positive 100. Participants with a score lower than negative 100 had a 38 percent mortality risk compared to two percent among those who scored positive 100 or higher.

The study abstract

Objective

To determine which routinely collected exercise test variables most strongly correlate with survival and to derive a fitness risk score that can be used to predict 10-year survival.

Patients and Methods

This was a retrospective cohort study of 58,020 adults aged 18 to 96 years who were free of established heart disease and were referred for an exercise stress test from January 1, 1991, through May 31, 2009. Demographic, clinical, exercise, and mortality data were collected on all patients as part of the Henry Ford ExercIse Testing (FIT) Project. Cox proportional hazards models were used to identify exercise test variables most predictive of survival. A “FIT Treadmill Score” was then derived from the β coefficients of the model with the highest survival discrimination.

Results

The median age of the 58,020 participants was 53 years (interquartile range, 45-62 years), and 28,201 (49%) were female. Over a median of 10 years (interquartile range, 8-14 years), 6456 patients (11%) died. After age and sex, peak metabolic equivalents of task and percentage of maximum predicted heart rate achieved were most highly predictive of survival (P<.001). Subsequent addition of baseline blood pressure and heart rate, change in vital signs, double product, and risk factor data did not further improve survival discrimination. The FIT Treadmill Score, calculated as [percentage of maximum predicted heart rate + 12(metabolic equivalents of task) – 4(age) + 43 if female], ranged from −200 to 200 across the cohort, was near normally distributed, and was found to be highly predictive of 10-year survival (Harrell C statistic, 0.811).

Conclusion

The FIT Treadmill Score is easily attainable from any standard exercise test and translates basic treadmill performance measures into a fitness-related mortality risk score. The FIT Treadmill Score should be validated in external populations.

 Now do it. 

But.  But.  But.

PAC MAN

FAAAAAHTS or Gastrointestinal colonization with methanogens increases difficulty of losing weight after bariatric surgery

Gastrointestinal colonization with methanogens increases difficulty of losing weight after bariatric surgery.

PAC MAN

This is totally my gut.
 
I feel like we knew this – have you lived with a gastric bypass or duodenal switch patient for a period of time?  I'm just saying, those of us with altered bariatric intestines  LIVE with "MARSH ASS."   Welcome to the world of pre-biotics, probiotics, fart-smell-better products and I kid you not, LINED UNDERWEAR.  

 
Hey, I never said I was a professional.  Read the studies.
 
What is a methanogen?  Wisegeek says —

"Methanogens are a type of microorganism that produces methane as a byproduct of metabolismin conditions of very low oxygen. They are often present in bogs, swamps, and other wetlands, where the methane they produce is known as "marsh gas." Methanogens also exist in the guts of some animals, including cows and humans, where they contribute to the methane content of flatulence. Though they were once classified as Archaebacteria, methanogens are now classified as Archaea, distinct from Bacteria.

Some types of methanogen, including those of the Methanopyrus genus, are extremophiles, organisms that thrive in conditions most living things could not survive in, such as hot springs, hydrothermal vents, hot desert soil, and deep subterranean environments. Others, such as those of the Methanocaldococcus genus, are mesophiles, meaning they thrive best in moderate temperatures.  Methanobrevibacter smithii is the prominent methanogen in the human gut, where it helps digest polysaccharides, or complex sugars."

Gut bacteria may decrease weight loss from bariatric surgery March 6, 2015
 

The benefits of weight loss surgery, along with a treatment plan that includes exercise and dietary changes, are well documented. In addition to a significant decrease in body mass, many patients find their risk factors for heart disease are drastically lowered and blood sugar regulation is improved for those with Type 2 diabetes.

Some patients, however, do not experience the optimal weight loss from bariatric surgery. The presence of a specific methane gas-producing organism in the gastrointestinal tract may account for a decrease in optimal weight loss, according to new research by Ruchi Mathur, MD, director of the Diabetes Outpatient Treatment and Education Center at Cedars-Sinai.

"We looked at 156 obese adults who either had Roux-en-Y bypass surgery or received a gastric sleeve. Four months after surgery we gave them a breath test, which provides a way of measuring gases produced by microbes in the gut," said Mathur. "We found that those whose breath test revealed higher concentrations of both methane and hydrogen were the ones who had the lowest percentage of weight loss and lowest reduction in BMI (body mass index) when compared to others in the study."

The methane-producing microorganism methanobrevibacter smithii is the biggest maker of methane in the gut, says Mathur, and may be the culprit thwarting significant weight loss in bariatric patient. Mathur and her colleagues are conducting further studies to explore the role this organism plays in human metabolism.

While that research continues, bariatric patients may still have options to improve weight loss after surgery.

"Identifying individuals with this pattern of intestinal gas production may allow for interventions through diet. In the future there may be therapeutic drugs that can improve a patient's post-surgical course and help them achieve optimal weight loss," said Mathur.

The study, "Intestinal Methane Production is Associated with Decreased Weight Loss Following Bariatric Surgery" was done in collaboration with the Mayo Clinic. The paper is being presented by Mathur Thursday, March 5, at the 97th annual meeting of the Endocrine Society in San Diego.

 

Baby

Bariatric surgery may improve pregnancy outcomes – mostly

Many women opt for bariatric surgery in order to increase chances of maintaining a healthy pregnancy.  A recent study suggests that weight loss surgery can help a woman do just that, but there are risks.

Personally, my full term post bariatric surgery pregnancy was different than my pre-WLS pregnancies.  I was at a more normal bodyweight at the time of my daughter's gestation, and I did not seem to suffer the ill effects of obesity on pregnancy like I had with my prior children.  I had no high blood pressure, no high blood sugar, nor did I land on bedrest – which I had with previous babies.    My post RNY pregnancy offered me anemia and rampant hypoglycemia.  I was not well. 

She was born healthy, but small, in comparison to my earlier babies.  I noted a lack of body fat at birth.  This is several weeks old.

Baby

My post bariatric surgery baby – my smallest birthweight baby.

 

New York Times

While the study found some risks for women who had surgery, including more babies born too small and a greater likelihood of stillbirths, experts said that overall the results were better.

The findings have implications for an increasing number of women and children, especially in the United States, where nearly a third of women who become pregnant are obese. Obese women have more problems in pregnancy, including gestational diabetes, pre-eclampsia, and stillbirth. Their babies are more likely to be premature, overweight or underweight at birth, have certain birth defects, and develop childhood obesity.

The study, published Wednesday in The New England Journal of Medicine, sought to find out if surgery could safely mitigate some of those effects. Swedish researchers, led by Kari Johansson, a nutritionist at the Karolinska Institute, evaluated records of 2,832 obese women who gave birth between 2006 and 2011, comparing women who had bariatric surgery before becoming pregnant with women who did not.

They found that women who had had surgery were about 30 percent as likely to develop gestational diabetes, which can lead to pre-eclampsia, low blood sugar, birth defects and miscarriage. They were about 40 percent as likely to have overly large babies, whose challenges can include lung and blood problems.

The outcomes were worse in some categories. Women who had surgery were twice as likely to have babies who were small for their gestational age, suggesting the need for better nutrition for pregnant women with surgically-reduced stomachs. And more of their babies were stillborn or died within a month after birth, although the number of such deaths in each group was very small and might have been due to chance, experts and the authors said. There was no significant difference in rates of premature births or babies with birth defects.

The study via NEJM –

BACKGROUND

Maternal obesity is associated with increased risks of gestational diabetes, large-for-gestational-age infants, preterm birth, congenital malformations, and stillbirth. The risks of these outcomes among women who have undergone bariatric surgery are unclear.

METHODS

We identified 627,693 singleton pregnancies in the Swedish Medical Birth Register from 2006 through 2011, of which 670 occurred in women who had previously undergone bariatric surgery and for whom presurgery weight was documented. For each pregnancy after bariatric surgery, up to five control pregnancies were matched for the mother’s presurgery body-mass index (BMI; we used early-pregnancy BMI in the controls), age, parity, smoking history, educational level, and delivery year. We assessed the risks of gestational diabetes, large-for-gestational-age and small-for-gestational-age infants, preterm birth, stillbirth, neonatal death, and major congenital malformations.

RESULTS

Pregnancies after bariatric surgery, as compared with matched control pregnancies, were associated with lower risks of gestational diabetes (1.9% vs. 6.8%; odds ratio, 0.25; 95% confidence interval [CI], 0.13 to 0.47; P<0.001) and large-for-gestational-age infants (8.6% vs. 22.4%; odds ratio, 0.33; 95% CI, 0.24 to 0.44; P<0.001). In contrast, they were associated with a higher risk of small-for-gestational-age infants (15.6% vs. 7.6%; odds ratio, 2.20; 95% CI, 1.64 to 2.95; P<0.001) and shorter gestation (273.0 vs. 277.5 days; mean difference −4.5 days; 95% CI, −2.9 to −6.0; P<0.001), although the risk of preterm birth was not significantly different (10.0% vs. 7.5%; odds ratio, 1.28; 95% CI, 0.92 to 1.78; P=0.15). The risk of stillbirth or neonatal death was 1.7% versus 0.7% (odds ratio, 2.39; 95% CI, 0.98 to 5.85; P=0.06). There was no significant between-group difference in the frequency of congenital malformations.

CONCLUSIONS

Bariatric surgery was associated with reduced risks of gestational diabetes and excessive fetal growth, shorter gestation, an increased risk of small-for-gestational-age infants, and possibly increased mortality. (Funded by the Swedish Research Council and others.)

PS.  Post RNY baby is eight years and four months old now.  She's fine.

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