Ask The Expert With Dr. Terry Simpson
March 4, 2013OH Member Michelle sent a few of her questions in to [email protected] and Doctor Simpson answered!
I have several questions that I've so far been unable to get answers to, including in my first "pre-surgery" orientation session (which covered broader topics). Can you please help?-Michelle
Michelle: Is it possible to obtain enough protein with a vegetarian diet post-op? (I'm considering a VSG but I would imagine the same question would be valid for any of the procedures?)
Doctor Simpson: Yes. It is quite easy to maintain a vegetarian diet as a post-op.
Michelle: How will my estrogen, progesterone and testosterone levels be affected? I know that many (if not all) of the sex hormones are stored in the fat cells and last year I had several problems associated with hormonal imbalance (which took many visits to diagnose and months to treat). I'm peri-menopausal and concerned the rapid weight loss post bariatric surgery will throw my hormones into a tailspin again.
Doctor Simpson: Sex hormones are not stored in fat cells, that is a myth. Weight loss does change how hormones work, but it is a bit more complicated- but all good.
Michelle: I have concerns about what is likely the lack of bulk in one's stools post-op (specifically restrictive, not malabsorptive procedures). I'm probably being paranoid but have there been any studies linking increased incidents of colon cancer to restrictive bariatric surgeries? Has anyone looked for a connection? How does one provide necessary bulk to one's stools with a post-op diet?
Doctor Simpson: There is no issue with stools with non-malabsorptive procedures. Take fiber and drink your water and you will be fine. There are no studies showing an increase in cancer with those procedures.
Michelle: And the "big" question: metabolically how do the surgeries work? That is, some folks achieve diabetes reversal and pre-diabetes reversal very rapidly after surgery--before drastic levels of weight loss have occurred. So there's something happening metabolically connected to insulin resistance and I'd like to understand that process better. Do the same metabolic results occur with both restrictive and malabsorptive surgical procedures?
Doctor Simpson: There are a lot of complexities with bariatric surgery and diabetes here are a few things:
(a) Eating less means you stress the system less, so you will have less need for making as much insulin. Often this reduction in food intake, many can get off oral agents right away.
(b) Bypassing the first part of the duodenum does bypass a part of the system that signals the pancreas to produce more insulin, and a part that helps facilitate glucose transfer - this does not happen in restrictive operations
(c) Weight loss is great for Diabetes -- think of fat as a big sponge for excess insulin.
Do you have a question to Ask The Expert? Email us at [email protected]!
Terry Simpson, MD, FACS is a bariatric surgeon practicing in Phoenix, Arizona, and is the author of several books about weight loss surgery, including Losing The Last 30 Lbs., available here. Visit Dr. Simpson at Yourdoctorsorders.com and doctorsimpson.com
