PLEASE READ BEFORE YOU HAVE GB

 I am 3 yrs out from my Gastric Bypass.  On paper, I'm a success, having lost 65% excess weight.  People tell me I look great.  Wonderful.  Three years later- I should have NEVER had this surgery.  I am NOT telling everyone not to have the surgery.  Instead, if you are thinking of gastric bypass or are close to surgery, please read my stories and listen to my advice, from someone who has gone through this.  

FIRST, everyone has a different make-up, physically and mentally.  The gastric bypass is not one size fits all.  There are all kinds of reasons we got to the extreme weight.  But I'm sure that myself included, most of us got to this weight via a mental void.  The food filled that void somewhat.  And the surgery can cause some remarkable weight loss.  However, how you feel on the inside after surgery could be a whole different story.

The psychiatric evaluation before the surgery is a joke.  Even with a documented history of minor mental disorders, I easily slipped through the cracks.  I knew that people with depression and addictive personalities were not good candidates for the surgery.  Three years later, what I thought were minor mental disorders turned out to be much greater.  I have Major depression (possibly bi-polar), extreme social anxiety, and compulsive addiction disorder.  The gastric bypass changes the physical anatomy, not the mental anatomy.  Not the brain.  Before the surgery, I also knew that smoking and alcohol was a NO.  And the thought didn't even cross my mind.  Until last year at 28 yrs old, I was the most straight-edge young guy out there.  Never smoked and drank once in a blue moon.  I was abhorred by cigarettes, mainly because for years I told my Dad to stop smoking and its at least 25% of the reason he had a heart attack and died at 61.  I also had a bad experience in college with drinking which really turned me off from the stuff.  Furthermore, when I tried marijuana in college, I had the worst experience of my life- a horrific panic attack that lasted for several hours and made me almost want to go to the ER.  

ADDICTION TRANSFER is the name of the game.  I'm telling you guys, I was the last person who would've turned to other substances.  They really don't tell you enough about Addiction Transfer in their little information sessions.  The food was the drug and it won't be anymore once you have surgery.  Because the experience of eating won't be nearly as satiating anymore.  Hence, people with mental disorders like myself MAY eventually turn to other things to fill in that Void.  Last year, I started smoking cigarettes and drank a ton of alcohol.  Then, I turned to Weed which got me off the alcohol a little bit but is just about as bad with the Gastric Bypass.  Most people out there say, "Just stop doing those things."  Its really laughable because they have no idea what they're talking about, unless they've been in the shoes of a person like me.  Needless to say, I now suffer from major abdominal pain brought upon by ulcers and unless I stop my current substance lifestyle , the Bariatric surgery team says I may die from ulcer-related major internal problems in the stomach and intestines.  I've been to ongoing therapy and through a whole host of anti-depressants- I am skeptically optimistic that these things will help me, just because for years, they haven't. 

Again, I stress that this post is NOT for everyone.  I have talked to so many people who've had the surgery and many experiences are fabulous success stories!  But, from what I realize now, I personally would not have had this surgery if I could take a time machine back.  And a person like me with major depression and compulsive addiction disorder should really do some research on addiction transfer or feel free to send me a message.  Please don't potentially ruin your life like I did.

I am so sorry to hear you are going through this.   Sadly you are not alone.    However, I do not believe this is something as simple as "addiction transfer" as many are so quick to apply an easy label to this.   There is an important study done recently done by Dr. Magdalena Plecka Ostlund of the Karolinska Institutet in Stockholm showing that those people that had weight loss surgeries that bypassed the intestines had much higher rates of problems with addiction, depression and attempted suicide than those that had the Lap-Band (or similar type).     I couldn't tell if you had RNY or LapBand or one of the other types of surgeries based on your post?

 

http://www.diabetesincontrol.com/index.php?option=com_content&view=article&id=10920-gastric-bypass-increases-risk-for-alcohol-abuse&catid=1&Itemid=8

 

But sadly, the big headline is "alcohol" and not the focus on the root cause of the addiction and other problems.  Here is an excerpt from the article:

 

"The gastric bypass surgery cohort had higher Hazard Ratios (HR) than the restrictive surgery cohort for substance abuse (HR, 3.8), suicide attempt (HR, 4.1), alcohol abuse (HR, 4.0), and depression (HR, 2.4). For the restrictive surgery cohort, these HRs were, respectively, 1.4, 2.4, 1.2, and 1.8, she said."

 

                              Gastric Bypass          Lap Band            % Increase

Substance  Abuse        3.8                        1.4                           2.7

Suicide Attempt            4.1                        2.4                          1.7

Alcohol Abuse              4.0                        1.2                           3.3

Depression                   2.4                        1.8                          1.3

 

 

I translated this to a table to show, though indeed alcohol abuse is a big problem, there is also a large increase in problems in substance abuse, depression and suicide attempts which are reflections that there is more going on here.

 

What I've come to discover over the past couple of years is that these “addictions" are likely being caused by malnutrition that is created by nutrient and amino acid deficiency.   This causes the brain to act strange and the patient to feel “wrong" or be in a constant state of "un-well-being" or "dis-ease" all the time and need to self medicate.   As soon as the drug of choice provides relief (such as alcohol or narcotics) the brain puts 2 and 2 together and comes up with WOW pretty quickly and creates those addictive pathways in the brain FAST!   But it could be other behaviors as well - shopping, gambling, sex, eating, exercise, etc.   Whatever.   But, these problems are not happening at nearly the same rate when the intestines are not bypassed - that is the key.

I figured the answer to getting my life back would be in attempting to compensate as much as possible for what the surgery took away from me, in terms of nutrients.   What did the intestines do (the duodenum and jejunum specifically), and how could I compensate for their role now that they were bypassed?    Once I was able to renourish my brain and my body, the need to self-medicate disappeared.   I slowly returned to my former self.

If you are interested there are some amino acids that can be quite effective in dealing with the symptoms that drive a person to self-medicate.   In my case, I felt deficient in endorphins (your body's "joy chemicals") and serotonin (that sense of "ahhh" and "well-being").    I added the amino acid DL-phenylalanine (DLPA) in the morning and afternoon (which boosts the endorphins) - WOW what an improvement and right away - no waiting 4-6 weeks.   I added 5-HTP throughout the day to increase serotonin.   I also added GABA and Taurine in the evening for relaxation.    You can feel a difference with DLPA within 30 minutes and you'll know whether or not it is working for you.    I place the GABA under my tongue as the effects are a bit more subtle (think of GABA as natural Valium or Xanax).

These, of course, are not a substitute for overall brain/body nourishment - but they can be effective in that difficult transition stage.  You will still forever have to compensate for what you've lost but amping up your absorbable protein (to get a good dose of ALL the amino acids), all the vitamins, minerals, as well as Omega-3 fish oil.   Your brain consists of approximately 30% DHA (a major component in fish oil).   Also, many of the aminos depend on certain vitamins to work properly, so it really is a package deal.

Another reason I think the aminos are so effective, is that a recent study the surgeons are terribly excited about that explains why this surgery is so effective at "curing" diabetes immediately (even before much weight is lost) and they discovered a huge drop in branched chain amino acids in the blood, which they believe is causing the cure in diabetes - BUT at what side effect?   They believe the amino acid drop is caused by protein malabsorption.

I am very empathetic to what you are going through and why you posted - so many have gone through this or are going this now.   Also, so many want to hide away, when they are no longer the poster child for success.  We need more people sounding this horn. 

If you are interested in a sample list of vitamins, doses, amino acids, etc, that I take daily I post it on my blog at:

http://www.itsnotaddictiontransfer.wordpress.com

Good Luck to you!   I hope you find something that works for you.

Lisa

IF what you are saying is true then a heck of lot more DS patients would be suffering worse problems than Gastric bypass patients - they malabsorb much more than we do.  A very small majority of GB patients are malnurished.  I do agree that when people are missing there food, they will substitute it with something else but I don't see how one surgery has any more incidence than any other one

There are a great major of WLS patients that develop a transfer addiction of excessive shopping and I certainly can't see how malnutrion can have anything to do with that.  I am far from malnurished and my labs have always been great, and I have had a terrible time with excessive shopping since my surgery.

I'm glad you brought that up.  Actually I have found out that although the DS patients do bypass quite a bit more intestine than the RNY patients they do not bypass the duodenum and upper jejunum which, as you know, is where many of the important nutrients are absorbed (ie., calcium, iron, magnesium, Vitamin A, B1, amino acids, etc).   I'm finding out, primarily anecdotally of course, that many of the DS patients are not having these problems like the RNY patients are.   (Some have suggested to me, that this may be solely a RNY issue).  I don't know if that is because there are fewer of them, or if it is because their duodenum wasn't bypassed, but I'd be interested to see if that data was available.   I did actually contact the author of the Karolinska study - we'll see if she responds.

As far as the labs go, unfortunately the labs don't always tell the whole story.   For example, magnesium, if they even test it, it is most always serum magnesum, which tells you very little regarding tissue magnesium levels.  Your body will maintain a stable blood level of magnesium pulling from wherever it needs to in order to maintain that value, so unless your doctor orders the EXAtest (which you usually have to request) you have no idea how deficient you really are.  

Other people have emailed me their labs with low symptomatic levels but are within the lab range yet are not within the optimum health range.   Most doctors just look at the labs and if nothing from the labs are flagged - they just ignore it.   But lab ranges and optimum health ranges are not the same.

That is if your doctor elects or knows to test for everything.   And there isn't even a test for all the nutrients that are essential for our health.   Most doctors often just run CBC.   Maybe B-12, D-3, TSH, T3, T4, ferritin if you're lucky.   And we haven't even touched on the micro-nutrients.  We are in uncharted territory here unfortunately.   For example, they just studied how this surgery cured diabetes and found our blood was much lower in certain amino acids.   That isn't a standard lab test with a typical optimum health range for branched-chain amino acids.

Another recent study shows that bone fractures for gastric bypass patients is even worse than previously indicated.   Also Peripheral Neurapathy is becoming a much more frequent ailment for gastric bypass patients.   Add that to the study showing teens losing their bone density.   These are all malabsorptive based issues.

Unfortunately, I also can relate to your shopping excess.   That too has been an all too common email to me.   But to me, they are all just different sides of the same coin - shopping is just a bit easier on the liver (can be more difficult on the bank account  though).  How we choose to cope with our feelings are just as varied as each and every one of us.   But when that "feeling or dis-ease" comes upon us - we each deal with it in our own way.

So much attention keeps being paid to the alcohol - and  - I agree,  the lack of metabolism makes alcohol more potent .  But it is the "wanting" or the "craving" for that sense of well-being or that feeling of "Ahhh" for everything to be all right  that drives the addiction.   The alcohol, drugs, shopping, gambling, sex, *****graphy, whatever is just the mechanism we choose to find relief.  

The malnutrition has just as much to do with shopping as it does with alcoholsim or substance abuse or depression - that is why I try to so hard to take the focus off the alcohol and focus it on the root cause - but the news media seems determined even though the data shows just as many problems in other areas.  

If you feel "wrong" you are going to go to whatever behavior provides comfort to you.  It may also depend upon the degree of nutrient defiency you are experiencing - or "how bad you are feeling". Someone may start off by being able to medicate themselves and achieving adequate relief with "shopping" or "snacking" but if they don't renourish their brain it may not be enough after a while and they may progress to depression or to harsher chemical substances.

I was able to find some overall relief to my brain, by replacing the vitamins, minerals, protein, etc. But I also now put some GABA under my tongue whenever I go into a store.   I was surprised at the difference, and stunned to find myself sticking to the list for the first time.   People would always say "make a list", "make a budget", "yada yada yada".   That was never the problem.  I made beautiful lists, budgets, etc, in Excel, in MS Access, whatever.   The problem came when I went to the store with the perfect list and ended up with the extra $200 worth of "necessities".

I get this - people cannot associate how shopping can be associated with malabsorption.   Many people couldn't understand how iron deficiency made people crave eating the ice shavings from the inside of the ice box, but it happens.   B-12 deficiency mimics dementia.  Cults utilise diet to make people docile.

You say you have had a terrible time with excessive shopping since your surgery.  This I would think would be a sign to you that something very different is going on with you?  Did you always have a problem with shopping?   Did you notice it getting worse at a certain period of time after the surgery?   This can be very problematic as well, and some minimize it because it "isn't alcohol".   But like I said earlier, as far as I'm concerned, the root problem is the same, so I hope you don't dismiss it.   I hope you at least consider that what I'm saying might have some merit before things get worse.

Regardless, I wish you the best of luck with the spending.   I know it can be very difficult on you personally and on your family and is a very frustrating issue to deal with.   It's hard enough for the average person in this economy, and throw this issue on top of things, and that just makes it doubly hard.    I appreciate you bringing up the DS issue as well - good point.

Best Regards.

Lisa

The DS bypasses the duodenum.

 It was my understanding that the DS procedure transected the bowels about 2-inches below where the duodenum starts.     I thought that was one of the reasons why people had the DS procedure when other gastric bypass surgeries failed - it provides greater weight loss and much less problems with severe nutritional deficiency.

http://www.dssurgery.com/procedures/revisional-weight-loss-surgery.php

Diagram - showing duodenum (at least a part of it anyway)
http://www.dssurgery.com/procedures/duodenal-switch.php

Maybe there are different variations?

It provides greater weight loss because it has much more bypass. Therefore, severe nutritional deficiencies are more common with the DS than with the RnY.

However, there is less chance of B12 deficiency compared to RnY. But that's about it.

Aall the fat soluble vitamins are a big problem because only about 10% of fat is absorbed. So that is why the ASMBS recommends taking an ADEK for DS but not for RnY. They also recommend more calcium supplementation for DS compared to RnY. Iron also must be supplemented just as for RnY.

In addition only 50% of protein is absorbed (compared to 70-80% for RnY) with a DS. Since your theory is that transfer addictions are a result of malabsorption of certain amino acids, DS has more issue with that than RnY. Also, RnY will eventually absorb most, if not all, of their protein. DS will never absorb it all even if absorption of macronutrients does increase over time with both surgeries.

 The DS does bypass much more intestine, the part responsible for protein absorption and fat soluble vitamins like you said, but the duodenum is responsible for absorption many of the most critical nutrients.   Add to that, nutrient absorption isn't uniform down the intestines.   So you give up more length of nutrient absorption with the DS which is why you must take the ADEK, etc., but you gain that first two inches or so of valuable nutrient absorption from the part of the duodenum that is kept.    These issues could also be related to the specific type of nutritional deficiencies that DS patients are likely to get compared to the ones RNY patients get.

I actually believe it is the nutrient malabsorption that is causing this rise in addictions more so than the amino acid deficiency.  When the diabetes study came out indicating the huge drop in branched chain amino acids after this surgery, I thought that could play a part as well, but I think the bigger component is the nutrient malabsorption.    

This could be quite intriguing news.   If the researchers kept track of the type of surgery the patients had, such as in the Karolinska study, which they must have to differentiate between Lap Band and RNY, then perhaps they can differentiate between RNY and DS, and see if there is difference there as well.   Then, at least, we'd know if this was a factor or not.

I really appreciate the point about the amino acids - that is a strong indication that amino acid deficiency is not the cause of these problems and can potentially rule that out, assuming that DS patients are not having these addiction problems as they appear not to be (anecdotal indication only).

I asked my surgeon about this yesterday at our support group meeting. He said that only a cuff of duodenum is kept (definitely not 2 inches) and that it isn't enough to significantly change nutrient absorption over RnY. He said it used to be thought it would make a difference but then DSers started coming up short in things like iron and now he has his DS patients supplement iron just like the RnYers do.

and much less problems with severe nutritional deficiency.

 I don't know about that!    B/c we have much greater malabsorption than RNYers, I would say our nutritional deficencies are greater, as well .