Gastric Bypass Surgery Also Reduces Diabetes: So Does Atkins and Low Carb

A new report is out that states gastric bypass patients lose more weight and they also reduce the incidence of diabetes, etc. They compared bypass to weight loss drugs and to diet, although direct comparisons cannot be made due to limitations of the studies.

We identified numerous reports on obesity surgery. Two RCTs of surgery compared to nonsurgical treatment were considered to be of limited relevance because they used surgical procedures that are considered obsolete. An observational study, the Swedish Obese Subjects (SOS) study,18-25 matched subjects on 18 variables, including gender, age, height, and weight. At 8 years of followup, among 251 surgically treated patients, the average weight loss was 20 kg (or 16 percent of body weight), whereas among 232 medically treated patients, the average weight did not change. We consider this study as providing conclusive evidence of the superiority of surgical treatment for the patients that were enrolled (middle-aged adults with a BMI of about 41 kg/m 2 ). The strength of this study is the extended duration of followup, documenting sustained weight loss and improved health up to 10 years following treatment. A series of reports from the SOS study support the superiority of obesity surgery compared to medical therapy in ameliorating or preventing the morbidities due to obesity such as hypertension, diabetes, and lipid abnormalities. At 24 months after surgery, among 845 surgically treated patients and 845 matched controls (two-thirds women, average age of 48, average BMI about 41), the incidence of hypertension, diabetes, and lipid abnormalities was markedly lower in the surgically treated patients (adjusted odds ratios of 0.02 to 0.38, depending on condition).25 At 8 years of followup, the effect of surgery on the reduction in diabetes risk was still dramatic (odds ratio = 0.16), whereas the effect on reduction in risk for hypertension did not persist (odds ratio = 1.01).19 However, significant decreases in both systolic (8.3 mm Hg) and diastolic (6.7 mm Hg) blood pressure persisted in the small (6 percent) subset of patients who underwent a gastric bypass and lost significantly more weight than the 94 percent of patients who underwent a vertical banded gastroplasty or gastric banding.18 Additional reports from the SOS study support a substantial benefit of surgery in reducing sleep apnea,20 symptoms of dyspnea and chest pain,20 and improving quality of life.23 The SOS study is the only one we identified that compares the effect on comorbidities between surgically treated patients and a concurrent control group receiving non-surgical treatment.

Weight loss outcomes were reported in a large number of RCTs comparing various surgical procedures and case series of specific surgical procedures. For patients with a BMI between 35-40 kg/m 2 , the data strongly support the superiority of surgical therapy, but cannot be considered conclusive yet, in the absence of a study with a concurrent comparison group. These studies support the conclusion that gastric bypass produces superior weight loss compared to gastroplasty procedures. The weight loss reported in surgical studies is an order of magnitude greater than weight loss reported in pharmaceutical or diet studies of obesity (weight losses of 20 to 40 kg at 1 or 2 years in surgical studies versus 2 to 5 kg in pharmaceutical studies), although direct comparisons cannot be made across studies.

And the study is trumpeting the fact that, "Perioperative mortality rates of less than 1 percent have been achieved by some surgeons and surgical centers." Translation: experienced surgeons have one person die after the operation for every 100 operations they perform.

I have a couple of points to make. First, I have no medical degree. I am a daughter of a retired surgeon and as my father continually tells me, "you can't get a medical degree by blood." But... (always a but), I am going to write in my low carb blog what I would tell my own daughter.

1. Surgery is dangerous. Experienced surgeons can get the mortality rate to 1 percent or less. What about less experienced surgeons? (Is it worth dying over?)

2. After the surgery they basically put you on Atkins, a high protein low-sugar diet. I think more study needs to be done if this factor also contributes to the lessening of diabetes after gastric bypass as all the low carb medical studies are now demonstrating. (Why not stick to Atkins from the beginning?) See the "after gastric surgery menu" or the "ongoing gastric bypass diet" at the end of this post for the high protein low carb menu.

3. I have a friend who is on the list for gastric bypass. His wife does Weight Watchers. Weight Watchers and Atkins can't coexist. For some people to be successful on Atkins, the whole household has to be on it. I would beg a family member to fully read Atkins, to have the whole household go on Atkins before trying gastric bypass. And this means that the person who does the shopping and the cooking MUST take the time to read all of the Atkins books and the South Beach books and the Protein Power books. No excuses. (And please read this post that talks about how things CAN change.)

4. I want you to take out a half cup measure and put in meat and veggies and try eating only that three times a day. If you don't like it, get used to it, that will be your menu for life.

Gastric Bypass Ongoing Diet from John Hopkins Bayview Medical Center

Nutritional Guidelines after Gastric Bypass Surgery
Gastric bypass surgery was developed to induce weight loss and to avoid the medical complications of severe obesity. The surgery greatly reduces the stomach to the size of a small egg. A healthy diet after surgery helps with healing and maintains nutritional health.

Making new food choices and developing new eating habits helps achieve and maintain weight loss and prevent nutrition-related deficiencies or complications such as anemia
and osteoporosis.

Key Points To Follow After Surgery:

1. Put protein first at meals. After surgery, protein helps heal wounds and helps reduce muscle loss. It is rich in important nutrients such as zinc, iron, and magnesium.

Protein Sources:
cottage cheese
cheese
dairy yogurt
egg substitute
beef, lamb
pork,
poultry
fish, shellfish
deli meat,
Lactaid® milk
buttermilk, skim or one percent
milk, soymilk
tofu and texturized vegetable protein

Chew red meats thoroughly to avoid serious problems, such as stomach obstruction or regurgitation.

2. Maintain a half-cup portion size at meals for the first six months after surgery. Increase portions thereafter to one cup. Frequent overeating at meals hinders weight loss and stretches the stomach. So if you exceed the one-cup portion, consult a doctor or dietitian.

3. Avoid high-calorie drinks. These include regular soda, pre-sweetened iced tea, fruit juices and alcoholic beverages. Substantial amounts of these drinks hinder weight-loss. Limit to no more than two cups or sixteen ounces per day. But the best advice is to avoid them.

4. Also avoid carbonated beverages because they can cause excessive discomfort and stretch the stomach.

5. Drink enough fluids. Consume at least six cups or forty-eight ounces of fluid a day. Remember to sip slowly and avoid gulping. A straw may help slow down or control fluid intake.

For the first month after surgery: Drink protein-rich fluid as much as possible. (Examples include: one percent or skim milk, nutrient supplements such as Ensure® or No-Sugar-Added Carnation Instant Breakfast® )

6. Eat slowly and stop eating and drinking when you are full. Pay attention to signs of fullness to prevent overeating. Overeating or bingeing can stretch the stomach and hinder weight loss or lead to problems with nausea and vomiting.

7. Stick to sugar-free, low-fat foods. Foods high in sugar and fat may cause diarrhea, abdominal discomfort or "dumping syndrome." And they can slow weight loss.

Dumping syndrome results from a rapid passage of food into the small intestine and shifts fluid too quickly into the intestine. The result often is diarrhea and dehydration. Cramping, sweating, flushed appearance, dizziness, weakness, and headache characterize dumping syndrome.

Examples of High-fat foods
potato chips
ice cream
fried food
fast food
High-fat meats:
bacon, sausage, hot dogs, pepperoni, bologna, and steaks
frozen entrees
cream soups
donuts, cakes, icing

High-sugar foods
regular soda
iced tea
lemonade
candy
cakes, cookies, pies
regular pudding and yogurt
regular gelatin
jelly, honey, marshmallows
sugar-coated cereal
regular hot chocolate

8. Each day, take two children's chewable multivitamins with iron for the first month after surgery. Look for "Complete" on the multivitamin label.

After a month, switch to an adult-formulated capsule or prenatal vitamin. Take one dose each day on a lifetime basis. In addition to a daily multivitamin, take a calcium supplement in the form of calcium citrate (500-600 mg). Women who are still menstruating may need an iron supplement.

9. The combination of swallowing air and a smaller stomach may cause frequent burping.

10. Some people may eat and drink at the same time may after surgery with no problem. Others may experience discomfort.

Update: Turtleway has more on medicare paying for this gastric bypass surgery....

Comments

[Donna]

While I respect your opinion, I have actually had gastric bypass surgery.

The example you gave of filling a 1/2 cup measuring cup is inaccurate. Before surgery 6 of those 1/2 cups wouldn't begin to make you feel "full", but after 1/2 cup is a lot of food and it registers as a lot of food. I actually eat 1 cup of food at a time, if I can finish it.

Also, the Atkins diet would be a poor choice for a post-op patient because of the fat content. That much fat would most certainly make one fell nauseated and could cause dumping itself. I don't dump on sugar, but it makes me feel unwell, (as does high fat food), so I do not crave them like I used to, even on a low carb diet. Also, my diabetes hasn't had to be treated since the day I had my surgery. I still needed medication while eat low carb prior to surgery.

Surgery should never be taken lightly, it is to be considered a last resort. But, I would rather die trying than stay morbidly obese and die from that! I have never had so much energy and felt better in my entire life!

I wish you all the best with your low carb path.

Donna

[Dieting-Home]

Today we issued the second press release in our Hitwise Holiday Series, highlighting the fact that search is driving 48% of visits to the top recipe sites as we approach Thanksgiving. I decided to take this opportunity to pull out one of my favorite charts that demonstrates the trade- off between searches for Thanksgiving Day recipes and visits to the major online dieting sites...

[Peggy Lee Maxwell]

I have had the gastric bypass surgery and can honestly say I was very sucessful with it I have lost 297 pounds since 1996. The difficulties I have found with having this for such a long term, is the food limitations still, and the long term effects of not being able to consume enough vitamins. For example green leafy vegetables are still a big issue after all these years. I have tried puree' but a salad just isnt the same once it hits the blender. ANyway I believe in the surgery and I am a sucess story....but I was fortunate because the doctor that did the bariatric proceedure here was thourough with pre surgery training and theory classes, and advised us how to make the lifestyle changes that make this surgery worth having.

[sharon]

I just had Gastric Bypass surgery on May 18th 2010 and I weighed 287 at my pre-op appt.nine days after my surgery I weighed 252 so I lost 35 lbs,and am feeling good I do have more energy and am excited that I can see the weight coming off,I have noticed it mostly in my face,hands and stomach,even my family and friends can see the change in me,I will post back in a month.

[Michelle]

It is NOT true that everyone who has gastric bypass cannot tolerate fats! I am doing Atkins as my post-op lifestyle, and I have no problem with fat. I feel great! I have no regrets for having GBS. I lost 150 lbs that I would NOT have lost without the surgery, even if I had been doing Atkins. I needed the restriction. It also gave me the time to make lifestyle changes and figure out why I ate so much in the first place. Now, at 135 lbs, I am able to use the Atkins low-carb lifestyle to maintain my weight loss. And I couldn't be happier! :)