Gastric Bypass & Alcohol Abuse

Researchers from the University at Buffalo Research Institute on Addictions in collaboration with the Penn State College of Medicine are investigating why a significant percentage of people who opt for a gastric bypass procedure for weight loss develop alcohol abuse problems.

The researchers plan to focus their study on the possible neurological causes for the increased vunerability for alcohol use disorders in this group of people.Senior research scientist; Dr Panayotis K Thanos stated: “Recent findings have shown the risk of developing an alcohol use disorder following gastric bypass surgery was nearly double the risk in the general population. Although other studies have shown the risk to be not quite that high, the numbers all point to the need for greater research in this area.”

Dr Thanos added; “Most alcohol use disorders manifest during a person’s teens or 20’s. However, people who have a gastric bypass tend to be older, so the alcohol abuse arises at a much later onset date than in the general population.” So this likelihood of developing alcohol problems is unusual because of the older age of the patients.

Alcohol

Results of the study could prove valuable to clinicians when they formulate personalised post operative treatment plans for patients who may already have an increased risk of alcohol use disorders, in order to help prevent develoment of the addiction.

Dr Thanos concluded; “We will explore whether this outcome is due to changes in the brain’s dopamine system that are a unique result of the gastric bypass surgery, and independent of weight loss or post surgical change of diet.  Such a change in the dopamine system may increase preference for an intake of alcohol based on its increased rewarding effects in the brain. This, in turn, poses an increased risk for development of addiction.”

Reference: Bariatric News Issue 28

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Side Effects Of Bariatric Surgery

Side Effects of Bariatric Surgery

Bariatric surgery is a procedure performed on obese individuals in order to help them achieve rapid weight loss. The risks associated with bariatric surgery fall into two main categories: those related to restricted food intake and rapid weight loss and those associated with the surgical procedure itself.

Accordingly, side effects can be categorized as:

hospital-IV

Immediate post-operative complications

  • Infection of the wound and of the operative site (affects around 1 in 20 patients)
  • Internal bleeding (occurs in around 1 in 100 patients)
  • Development of blood clots (occurs in around 1 in 100 patients). Clots may develop in leg veins (deep vein thrombosis) or travel up to the lungs causing a pulmonary embolism, which can be life threatening.

Death

The immediate complications of bariatric surgery can result in a patient’s death. Pulmonary embolism, severe bleeding, major infection, stroke, or heart attack are all conditions that put the patient’s life at serious risk. The estimated risk of death after gastric band insertion is around 1 in 200 and after the gastric bypass the risk is around 1 in 100.

Factors that raise the risk of dying due to post-operative complications include age, male gender, high blood pressure, increased risk for pulmonary embolism and a body mass index of 50 or above. Risks for pulmonary embolism include a history of pulmonary hypertension, deep vein thrombosis, and blood clots.

Development of gallstones

Gallbladder

Gall bladder stones are a common outcome of bariatric surgery, with stones developing in around 1 in 12 individuals. Gallstones are aggregates of chemicals and cholesterol that eventually clog up the gall bladder. The stones may be symptomless or may cause intense pain in the abdomen as well as nausea, vomiting and jaundice.

Stoma blockage

Stoma blockage is a common complication of gastric bypass surgery that occurs when the opening (stoma) that connects the stomach pouch to the small intestine becomes blocked by a piece of food, resulting in persistent vomiting. The condition occurs in around one-fifth of patients and is treated by directing a small flexible tube called an endoscope into the stoma where a balloon attached to the endoscope is inflated to remove the obstruction. To avoid stoma blockage, food must always be taken in small bites and chewed thoroughly.

Excess skin

excess skin

 

Rapid weight loss among obese individuals results in skin becoming excessively loose and folded. Folds of skin are most typically acquired around the breasts, back, abdomen, limbs, and hips and are normally most apparent 12 to 18 months after surgery. The folds can be unsightly and may harbour moisture leading to infections and rashes. These excess skin flaps can be removed and the skin tightened using cosmetic surgery.

 

Effects on mental health

Rapid weight loss may have a detrimental effect on mental health, with many patients suffering from depression and anxiety after surgery. Patients may also develop relationship problems with their partner. Additionally, social occasions orientated around meals may make the patient feel isolated and anxious due to their much reduced appetite and restricted diet.

Slippage of the gastric bandband slippage

Gastric band slippage is a problem that affects around 1 in 50 patients who have had an adjustable band fitted. The band slips out of position and the stomach pouch becomes bigger than it should be, resulting in nausea, vomiting and heartburn. It is not life threatening but further surgery could be required to repair the slippage.

 

Intolerance to foods

Food intolerance occurs in around 1 in 35 patients who have had bariatric surgery and may develop years after the procedure. Foods such as red meat may bring on heartburn, nausea and vomiting.

 

Reference:

By Dr Ananya Mandal, MD

Reviewed by Sally Robertson, BSc

 

Source News Medical

The Role Of The Vagus Nerve In Weight Loss Surgery

 

The vagus nerve has long been recognised as the internal sensory system, regulating breathing and heart rate among, as well as sensing and signalling that feeling of fullness to the brain. That same nerve also detects nutrients and controls digestion. Yet how it receives the information it uses to perform these tasks has been less well-known.

To trigger that feeling of fullness, does just one wire need to be activated, or are there several that need to be activated? How is this sensory system organised to distinguish proteins from carbohydrates or lipids, and then how does it send messages to secrete enzymes that will digest each of them?

Peering into the gut-brain connection in mice, Harvard Medical School researchers led by Stephen Liberles discovered two distinct types of sensory neurons that survey the status of the gastrointestinal tract: one senses stretch in the stomach and one responds to the presence of nutrients in the intestine.

The findings, ‘Sensory Neurons that Detect Stretch and Nutrients in the Digestive System’, published in the journal Cell, have potential relevance for understanding how bariatric surgery not only achieves weight loss but also diminishes Type 2 diabetes. In addition to weight loss, the work may be relevant for disorders of intestinal motility, such as dyspepsia.

 

“Using genetic tools, we were able to classify two major cell types that differentially innervate the GI tract,” said Liberles, HMS associate professor of cell biology and senior author of the paper. “One cell type broadly accounts for several classes of stretch receptors in the stomach and intestine. Another cell type is completely different, detecting nutrients.

The neurons that sense stretch in the stomach produce receptors for glucagon-like peptide 1 (GLP-1), a hormone released from the intestine in response to the arrival of nutrients. GLP-1 analogs are powerful anti-diabetic drugs. While it might seem likely that neurons containing the GLP-1 receptor would respond to nutrients, the team’s experiments instead showed they were sensitive to mechanical stretch of the stomach and the intestine.

These neurons, the researchers found, project to the muscular wall of the stomach but not to the inner surface of the intestine where nutrient detection occurs.

Nutrients are detected by GPR65 neurons, which express receptors for the hormone serotonin. Specific in purpose, these neurons sense nutrients that travel through the intestine through projections that end in the intestinal villi, tiny peninsulas that line the intestine and aid in food absorption.

The GPR65 neurons held another surprise: They respond to all sorts of chemical cues from food in the intestine, whether that cue is a sugar or fat or protein or salt or a change in pH balance.

“Here you have one neuron informing the brain on just about everything,” Liberles said, “which is a much less specific role than we were expecting going in.”

Also unexpected was the finding that the two nerve cell types project to different regions within the same nucleus in the brain stem.

“The two types form non-overlapping projection fields right next to each other, suggesting that each type sends information to different circuits in the brain,” said Erika Williams, an HMS graduate student in cell biology. “They are engaging different brain pathways and presumably then orchestrating different, multi-organ physiological responses.”

Liberles said there might be pharmaceutical targets for the regulation of food intake, perhaps the receptors that modulate responses to nutrients.

“The tools we used – optogenetics, imaging, and neural mapping – allowed us to paint a comprehensive picture of what these neurons do,” said Liberles. “That capability could in future studies help us understand how these neurons work at a molecular level: What are the key receptors that detect stretch of the stomach or nutrients in the intestine, or even other sensory cues outside the GI tract.”

Title of Paper: Sensory Neurons that Detect Stretch & Nutrients In The Digestive System

Paper Reference: DOI:10.1016/j.cell.2016.05.011

Published in the Journal Cell

 

Weight Regain? Put A Ring On It!

Weight Regain After A Gastric Bypass? Put A Band On It!

Low-pressure gastric band / adjustable
BioRing Adjustable Gastric Band

Dr Rudolf Steffen is a bariatric and metabolic surgeon at the Hirslanden Klinik Beau-Site in Bern, Switzerland, one of the leading centres in the country for bariatric and metabolic surgery. Since 2003, he has performed more than 3,000 banded bypass operations.

 

“The reasons why patients experience weight regain two years after a gastric bypass is because it is a restrictive operation and if the restriction fails, the patients regain weight,” began Professor Steffen. “In our experience, 29% of 404 patients in the fourth year after unbanded bypass required a pouch revision with a band for weight regain because of loss of restriction. Percentages increasing thereafter.

As a result, he recommends banded bypass to all his bypass patients who are suitable for the procedure, after explaining the advantages and disadvantages of the procedure and he informs them that in his opinion, there is good, but limited data. He also recommends a banded bypass for revision procedures, primarily for those patients who received a gastric band in the mid 90’s.

 

Gastric-Bypass (1)

“I explain that approximately 50% of patients will probably not need one but there is no way to know who these patients are,” he added. “In addition, I tell them that about half of all bypass patients will need a reoperation due to a loss of restriction. It is important to give our patients as much information as possible so they can make an informed decision. Some patients may not like the idea of having a foreign body inside them, so they just have a bypass.”

He said that he does not perform many sleeve gastrectomies (20 or so a year), as he do not want a restriction in the same location where a leak might occur and explained that he views the sleeve as a high-resistance tube, so in the first instance it does not require a band.

“However, a banded sleeve can be considered in a secondary case, but in such cases I usually convert the sleeve to a bypass.”

 

band-over-bypass1

 

Professor Steffen said that it is important to understand the mechanisms of a banded bypass and many people are under the misapprehension that the goal of a banded bypass is to make people lose more weight. He clarified this by stating that the goal of the banded bypass is not to regain weight, which has been demonstrated in several multi-centres studies that showed after two or three years, the non-banded patients reported more weight regain.

“If a bariatric surgeon chooses not to place a ring, in my opinion, it is justified because we do not have the long-term data yet from prospective, randomised clinical trials,” he concluded. “However, in my experience it is of benefit to explain the procedure to gastric bypass patients. The ring can always be placed in a revision procedure if the patient has weight regain or presents with hyperglycaemia.

Why Are Children Becoming Overweight?

What Causes Obesity in Children?

Children become overweight and obese for a variety of reasons. The most common causes are genetic factors, lack of physical activity, unhealthy eating patterns, or a combination of these factors. Only in rare cases is being overweight caused by a medical condition such as a hormonal problem. A physical exam and some blood tests can rule out the possibility of a medical condition as the cause for obesity.

Although weight problems run in families, not all children with a family history of obesity will be overweight. Children whose parents or brothers or sisters are overweight may be at an increased risk of becoming overweight themselves, but this can be linked to shared family behaviours such as eating and activity habits.

A child’s total diet and activity level play an important role in determining a child’s weight. Today, many children spend a lot time being inactive. For example, the average child spends approximately four hours each day watching television. As computers and video games become increasingly popular, the number of hours of inactivity may increase.

Children TV

What Diseases Are Obese Children at Risk For?

Obese children are at risk for a number of conditions, including:

  • High cholesterol
  • High blood pressure
  • Early heart disease
  • Diabetes
  • Skin conditions such as heat rash, fungal infections, and acne
  • Bone problems

 

How Do I Know if My Child Is Overweight?

The best person to determine whether or not your child is overweight is your child’s doctor. In determining whether or not your child is overweight, the doctor will measure your child’s weight and height and compute his ”BMI,” or body mass index, to compare this value to standard values. The doctor will also consider your child’s age and growth patterns.

Girl being weighed by doctor.
GP Checking Child’s Weight & Height

How Can I Help My Overweight Child?

If you have an overweight child, it is very important that you allow him or her to know that you will be supportive. Children’s feelings about themselves often are based on their parents’ feelings about them, and if you accept your children at any weight, they will be more likely to feel good about themselves. It is also important to talk to your children about their weight, allowing them to share their concerns with you.

It is not recommended that parents set children apart because of their weight. Instead, parents should focus on gradually changing their family’s physical activity and eating habits. By involving the entire family, everyone is taught healthful habits and the overweight child does not feel singled out.

How Can I Involve My Family in Healthful Habits?

There are many ways to involve the entire family in healthy habits, but increasing the family’s physical activity is especially important. Some ways to accomplish this include:

fitness-a-family-affair

 

  • Lead by example. If your children see that you are physically active and having fun, they are more likely to be active and stay active for the rest of their lives.
  • Plan family activities that provide everyone with exercise, like walking, biking, or swimming.
  • Be sensitive to your child’s needs. Overweight children may feel uncomfortable about participating in certain activities. It is important to help your child find physical activities that they enjoy and that aren’t embarrassing or too difficult.
  • Make an effort to reduce the amount of time you and your family spend in sedentary activities, such as watching TV or playing video games.

Whatever approach parents choose to take regarding an overweight child, the purpose is not to make physical activity and following a healthy diet a chore, but to make the most of the opportunities you and your family have to be active and healthy

SOURCES:

The Centres for Disease Control

The National Institute of Diabetes and Digestive and Kidney Diseases

What About Protein After A Gastric Band?

The Gastric Band & Protein

When you have had a gastric band placed there is no need to increase your protein intake however the recommended daily amounts still apply. This is 55g per day for an adult woman but the requirements are higher for those who engage in a lot of exercise. Often band patients neglect to eat protein as it requires more chewing and is more difficult to eat.

Once you resume eating normally after having your gastric band it is a good idea to eat your source of protein first. It may be more challenging to eat and will require more chewing than other food types. It is important that you really do chew your food well before swallowing, as this helps the digestive process. As you chew saliva is produced and saliva contains digestive enzymes that start to break down the food into smaller components that the body can absorb and use.

 

You do not need to drink a protein shake routinely just because you have a gastric band. These may be useful if you are on the go a lot and find it difficult to eat healthily. However a word of caution, some contain large amounts of sugar and these should be avoided. It is far better to eat real protein foods, focussing on the low fat plant proteins with some lean cuts of meat and fish. Avoid creamy or buttery sauces while trying to lose weight post-surgery as they are very high in calories.

 

The PVC Rule!

Eat the PROTEIN on your plate first.

Next eat the VITAMINS and minerals found in your vegetables or salad.

Lastly eat the CARBOHYDRATE content of your meal.

Gastric band diet plate

Why Protein Is Important

Protein is essential for the growth and repair of all the body’s cells, we cannot survive without it. It’s a good idea to eat a little bit of protein with every meal every day. Protein helps us to feel full for longer and stabilises blood sugars. Keeping blood sugars stable throughout the day is key to weight control, because if blood sugars are fluctuating all over the place we are more likely to crave sugary high calorie foods and therefore make poor food choices.

More About Protein

There are two types of protein- complete and incomplete. This classification refers to how many amino acids the protein contains. Amino acids are the building blocks of life. To keep it simple: animal products like milk, eggs, cheese, meat and fish are all complete proteins. They contain all eight essential amino acids. The only exception to this rule is food made from soy protein (such as tofu), this is also a complete protein.

Plant foods like grains (wheat, oats, barley and rye), lentils, beans, pulses, nuts and seeds are called incomplete proteins because on their own they do not contain all the essential amino acids. However, in combination they do. Therefore if you are vegetarian, or eating very little meat or fish, it is important to understand how to combine your proteins to make sure you are getting all the amino acids your body needs.

 

For example:  peanut butter on toast =a complete protein; lentils and rice = a complete protein.

Protein

Animal proteins like meat and dairy products are much higher in saturated fat than plant based proteins. These should be eaten in small amounts and not every day Also think about portion size, a portion of cheese need be no bigger than a small box of matches. A portion of meat needs to be no bigger than a pack of playing cards. Butter is fine to eat but should be spread thinly.

To summarise after having a gastric band be aware of your protein intake and stick to the Eight Golden Rules!

 

Getting Active & Fit After Gastric Banding

Top Tips For Getting Fit After A Gastric Band

Getting Started 

Before you embark on any exercise programme ensure that your surgeon or GP is happy for you to start exercising.

GETTING fIT

Walking is the best way to get started and completely free of charge! If your joints can’t handle it be brave and try the swimming pool, or an exercise bike as this will take the pressure off the joints until you have lost more weight.

Plan your exercise programme because unless it fits in with your life you won’t do it. The best is little and often as this is as beneficial as one long exercise session. Try and find a friend to exercise with you, this will help keep you motivated.

Up Your General Activity 

You can burn calories and keep reasonably fit without formally exercising and without even noticing which is great if you are not an exercise enthusiast!

 

Top Exercise Tips

Stairs

  • Get out of the lift 1 floor early, avoid escalators and use the stairs.
  • Park a small distance away from your destination and walk rather than try to find a closer parking space.
  • If you are travelling by bus, get off a stop earlier and walk the rest.
  • While watching TV challenge yourself to get moving during the commercial break.
  • Housework burns a lot of energy so count this as a workout and get scrubbing and spring cleaning.
  • Gardening is great exercise plus you benefit from being outside in the fresh air.
  • Avoid energy saving devices as you want to be using energy, not saving it!
  • Climbing the stairs is a great workout and a fantastic energy burner. If you take the challenge to try every second step your legs and bottom will benefit from additional toning.
  • Try and avoid prolonged periods of sitting, take regular breaks to walk around and stretch, this will also help your back and shoulders.

Gardening

 

Fun Toning – Wherever and whenever you can!

 

  • Brushing Teeth Squats – Squat as you brush. Lower your bottom in line with your knees and hold on to the sink if needed. Repeat 10 – 20 repetitions.
  • Worktop Press Ups – Stand with your feet approximately 1 metre away from the top and place your hands on the counter top. Bend your elbows to lower your chest towards the top of the counter then push away to straighten the elbows.
  • Washing Up Balance or Shaving Balance – Stand on one foot and hold as long as possible. Switch foot and repeat- this is great for legs, abdominal and lower back strengthening.

 

Gradually make exercise part of your regular routine, when you start to feel and see the difference it will motivate and inspire you to continue plus you will reap the rewards of the health benefits and enhance weight loss. Try and work out outside perhaps join a community group and make it a social event!

People exercising