Before you choose Gastric Bypass (RNY) Read This:
The first 3 words "A pilot study.." indicate it is not a long range study. If were a long range study with a large population, then it would have more credibility. DAVE
Dave Chambers, 6'3" tall, 365 before RNY, 185 low, 200 currently. My profile page: product reviews, tips for your journey, hi protein snacks, hi potency delicious green tea, and personal web site.
From my own experience and a lot of what I have read it appears this study is right on target. I have pretty strong RH and live with it every day. I think if I didn't get sick I would gain weight though. I can go a whole day without eating and feel fine, but if I eat a carb I am definately going to have RH and then have to eat again, its better to avoid carbs as much as possible. I guess this is going to push the VSG surgery to the new gold standard, although I am not convinced once the stomach stretches out some that weight gain won't happen with it either.
On July 27, 2011 at 7:59 AM Pacific Time, Joanne B. wrote:
From General Surgery News......Recent studies are showing that the significant weight regain many see after the gastric bypass is due to mechanical changes of the surgery, not due to the compliance of the patient. What this means, is it is NOT just up to the attitude of the patient and the effort they put forth to lose weight - there is a real physical reason as to why many people regain weight.
ISSUE: JULY 2011 | VOLUME: 38:7
Study Makes Case for Pylorus-Preserving Bariatric Operations
Major Fluctuations in Blood Sugar May Be Root of Weight Regain in Gastric Bypass Patients
by Gabriel Miller
San Antonio—A pilot study charting the rise and fall of insulin in bariatric surgery patients suggests that the dumping syndrome seen in some gastric bypass patients may be related to the higher rates of weight regain associated with that operation.
On a basic level, the study documents how vertical sleeve gastrectomy, duodenal switch and Roux-en-Y gastric bypass each affect post-meal insulin levels; however, on a deeper level, the paper suggests that pylorus-preserving operations may be superior for long-term weight loss because these procedures are more likely to better control glucose homeostasis and hunger. The study, funded by Covidien, was presented at the 2011 annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (abstract S087).
“I think it’s been fairly well established that bariatric surgery is an effective treatment, but less is known about glucose regulation and homeostasis after these operations," said Mitchell Roslin, MD, chief of obesity surgery at Lenox Hill Hospital in New York City, and the study’s lead author.
“There is something in the physiology of the [gastric bypass] operation that we’re designing that’s encouraging [dumping syndrome], and I think that we really have to be thinking more about normal glucose regulation going forward," Dr. Roslin added. “We believe we may be getting more physiologic glucose regulation doing a duodenal switch or vertical sleeve gastrectomy."
Although dumping syndrome is a well-established clinical phenomenon, Dr. Roslin took a greater interest during a trial studying revisional options for patients in whom gastric bypass was not successful. In that population, he heard a lot of patients “complaining of inter-meal hunger, feeling lightheaded and very hungry one to two hours after eating—symptoms that sounded an awful lot like hypoglycemia.
Dr. Roslin looked retrospectively at some of the data he was collecting and found abnormal glucose tolerance in patients who had gastric bypass, suggesting that “reactive hypoglycemia was causing a significant amount of hyperinsulinemia and hypoglycemia." The hypoglycemia, he believed, was leading to maladaptive eating behaviors and the subsequent weight gain.
As a step toward confirming this hypothesis, Dr. Roslin set up the current prospective study, which compared glucose homeostasis following gastric bypass, duodenal switch and vertical sleeve gastrectomy. The design provided comparisons with two pylorus-preserving operations and two intestinal bypass operations.
So far, Dr. Roslin collected six-month data on 26 self-selected patients—seven Roux-en-Y gastric bypass (RYGB) patients, 12 vertical sleeve gastrectomy patients and seven duodenal switch (DS) patients.
At this point, the main outcome measures are glucose and insulin responses to an oral glucose tolerance test (OGTT), given preoperatively to obtain baseline data and again six months after the operations. As the study progresses to include 60 patients with 12-month follow-up, it also will look into other measures, like response to a solid meal challenge.
To date, the data show all of the operations were successful, with patients experiencing weight loss (percentage of total body weight) of an average of 18% for RYGB and 28% for DS at six months. All of the operations also produced significant decreases in insulin sensitivity and hemoglobin A1C (HbA1C) levels at six months. Similarly, all of the operations improved patients’ glucose response in the OGTT administered six months postoperatively.
However, the insulin responses to the glucose tolerance test differed dramatically. “This is where it really becomes very interesting," Dr. Roslin said.
In the OGTT given six months after surgery, at time zero, the RYGB patients’ insulin levels were lower than those of the sleeve gastrectomy and DS patients—a lower fasting insulin level. But at one hour after ingesting glucose, the bypass patients had insulin levels that skyrocketed above those of the sleeve gastrectomy and DS patients, which rose and fell far less dramatically.
“When we look at insulin levels, fasting insulin levels go down appreciably with gastric bypass," said Dr. Roslin. “But when we stimulate with glucose, the amount of insulin goes up 20-fold at one hour approximately, and [at two hours] the insulin level is higher than what we see at baseline."
As a result, the glucose levels in RYGB patients also fell faster and to lower levels than those in patients who had sleeve gastrectomy or DS, ultimately leaving gastric bypass patients with lower glucose levels than at baseline before they consumed a meal.
“This is a fantastic study," said William Richards, MD, a professor and chair of surgery at the University of South Alabama in Mobile, who was not involved in the research. “We’re starting to elucidate some of the reasons why gastric bypass is associated with some significant weight regain over the longer term."
Alternatively, the study can be seen as supporting the pylorus-preserving bariatric operations. This study shows that “the pylorus is an effective means to modulate energy, and with that preserved pylorus in duodenal switch and sleeve gastrectomy, you get certain benefits," said Daniel Cottam, MD, a bariatric surgeon at the Surgical Weight Loss Center of Utah, in Salt Lake City.
Of course, glucose regulation is just one aspect of a bariatric operation. In the case of gastric bypass, a surgeon might be revising because of patient weight regain, but he or she might also be revising DS patients at the same rate because of nutritional deficiencies resulting from that operation.
And because individual surgeons’ results are so often tied to patient screening, education and follow-up, it can be difficult to tell whether the results are purely physiologic. Thus, the study also begs a more fundamental question: Should bariatric surgeries be promoted as “physiologic" operations that cause weight loss and resolve comorbidities, or are they merely tools that help modify eating behaviors?
“If we are going to do bariatric surgery and say that patients get better because of what we are doing to their physiology, then we can’t say they are noncompliant if they gain weight," Dr. Roslin said. “If it’s physiology on the way in, then it’s got to be physiology on the way out."
I am a survivor of this nightmare, and I'm now a bona fide DSer, survivor of severe morbid obesity and failed gastric bypass. Cheers!
I think this study is very true and people do need to be aware of WLS choices and choose the one they feel they can live with.
I've been around OH a while (over 6 years) and as Ms. Batts stated when I started on OH I don't recall reading anything on reactive hypoglycemia and if I did there wasn't much discussed about it. I've recently seen more post on reactive hypoglycemia AND seizures. Related to RNY, IDK but it DOES concern me.
I AM a successful RNYer and I've had 4 sugar drops in the last 6 years; I feel fortunate to not be one of the people that deal with RH it's a scary feeling when you feel an episode coming on. I had gestational diabetes with both of my boys so when I felt disoriented and shaky I knew what I needed to do for me.
It is important, again IMO, that these studies be put out there for anyone researching WLS today. You (general) need to know that things can/do happen post-op. I often consider myself a guinea pig for RNY.......we continue to learn more about the surgery and have lots of uncertainty of the future.
I've been around OH a while (over 6 years) and as Ms. Batts stated when I started on OH I don't recall reading anything on reactive hypoglycemia and if I did there wasn't much discussed about it. I've recently seen more post on reactive hypoglycemia AND seizures. Related to RNY, IDK but it DOES concern me.
I AM a successful RNYer and I've had 4 sugar drops in the last 6 years; I feel fortunate to not be one of the people that deal with RH it's a scary feeling when you feel an episode coming on. I had gestational diabetes with both of my boys so when I felt disoriented and shaky I knew what I needed to do for me.
It is important, again IMO, that these studies be put out there for anyone researching WLS today. You (general) need to know that things can/do happen post-op. I often consider myself a guinea pig for RNY.......we continue to learn more about the surgery and have lots of uncertainty of the future.
Proximal RNY Lap - 02/21/05
9 years committed ~ 100% EWL and Maintaining
www.dazzlinglashesandbeyond.com
NoMore B.
on 7/27/11 5:44 am
on 7/27/11 5:44 am
Of course there are people successful with the RNY, just as there are people successful with any surgery. I think if you look long term vs short term, though, you will see a higher rate of regain as compared to, for example, the DS. People need to look at statistics and not antecdotal evidence.
I hope studies like this one help ease some of the frustration I see with RNY'ers that are regaining. However, just becaause hypoglycemia might be a reason for the hunger and regain, it doesnt necessarily doom the RNY'er to a life of certain regain. I have read many people be able to keep things in check by eating a low glycemic diet, and also a diet of filling foods that stay in the pouch longer to maintain a feeling of fullness. To me it's just another thing that goes into the decision process of chosing a surgery and managing our obesity problems.
I also hope studies like this show pre-ops that they have choices beyond the RNY if they seek them out. My intent isn't to start a surgery war, though. I have the DS and am thrilled with it, but I also work in healthcare and feel pretty certain that in another 5-10 years there will be new surgeries we haven't yet imagined, or at least modifications to the ones that we have, that are better than the choices we have today. At that point I'm also fairly certain I would not have wanted to trade those 5-10 years living as healthy and no longer obese to wait for them to come along. It's all about making the best choice at a given time, to me.
I hope studies like this one help ease some of the frustration I see with RNY'ers that are regaining. However, just becaause hypoglycemia might be a reason for the hunger and regain, it doesnt necessarily doom the RNY'er to a life of certain regain. I have read many people be able to keep things in check by eating a low glycemic diet, and also a diet of filling foods that stay in the pouch longer to maintain a feeling of fullness. To me it's just another thing that goes into the decision process of chosing a surgery and managing our obesity problems.
I also hope studies like this show pre-ops that they have choices beyond the RNY if they seek them out. My intent isn't to start a surgery war, though. I have the DS and am thrilled with it, but I also work in healthcare and feel pretty certain that in another 5-10 years there will be new surgeries we haven't yet imagined, or at least modifications to the ones that we have, that are better than the choices we have today. At that point I'm also fairly certain I would not have wanted to trade those 5-10 years living as healthy and no longer obese to wait for them to come along. It's all about making the best choice at a given time, to me.
feel pretty certain that in another 5-10 years there will be new surgeries we haven't yet imagined, or at least modifications to the ones that we have, that are better than the choices we have today. At that point I'm also fairly certain I would not have wanted to trade those 5-10 years living as healthy and no longer obese to wait for them to come along. It's all about making the best choice at a given time, to me.
Great comment, Joanne. I agree!
Great comment, Joanne. I agree!
Proximal RNY Lap - 02/21/05
9 years committed ~ 100% EWL and Maintaining
www.dazzlinglashesandbeyond.com
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