Bad news for the bariatric-surgery industry: a Mayo clinic study released this week suggests that people who’ve undergone weight-loss surgery are more likely to break their bones. Here’s the first paragraph from the wire story:
It isn’t just the thunder thighs that shrink after obesity surgery. Melting fat somehow thins bones, too. Doctors don’t yet know how likely patients’ bones are to thin enough to break in the years after surgery. But one of the first attempts to tell suggests they might have twice the average person’s risk, and be even more likely to break a hand or foot.
Given how aggressively the bariatric centers are promoting these procedures, I suspect they’ll put a good spin on this. Pretty soon we’ll be seeing ads that read:
“The last time Mary Blarch broke her pelvis, she spent five miserable months in a size-24 cast. But after shattering both legs in the year following her gastic bypass procedure, she’s practically swimming in her size-6 cast. She only wishes there was more room for people to write their ‘get well’ messages on the plaster!”
I’m glad the study got some media play, but I have a bone to pick with the writer: These people are not ending up with thin bones because they’re “melting fat.” They’re ending up with thin bones because they had weight-loss surgery. That’s a rather important distinction for a medical writer to make.
Here’s another fun paragraph from the article about the study:
A quarter of the 142 surgery recipients studied so far experienced at least one fracture in the following years, Mayo’s Dr. Elizabeth Haglind told the endocrinology meeting. Six years post-surgery, that group had twice the average risk. But in a puzzling finding, the surgery recipients had even more hand and foot fractures than their Minnesota neighbors, three times the risk.
It isn’t all that puzzling. I don’t have a copy of the research paper, and the article doesn’t specify how many of the people studied were the victims of gastric bypass versus the lap-band, but I would guess gastric bypass is far more likely to produce brittle bones. Here’s why:
The lap-band procedure squeezes your stomach down to a fraction of its former size – about the size of a golf ball. You lose weight because you are limited to tiny meals, which (if you’re following the recommended diet) consist almost entirely of proteins and non-starchy vegetables. Yes, that would make it a low-carbohydrate diet.
Gastric bypass is much more radical. The surgeon cuts apart your stomach and uses the top portion to make an itty-bitty stomach. (They call it a “pouch”… isn’t that cute?) The itty-bitty pouch is then connected directly to the middle of your small intestine, bypassing the evil duodenum. And why is the duodenum evil? Because that’s the part of your small intestine that aborbs fat. The surgery centers that sell gastric bypass procedures even brag about this effect:
Gastric Bypass Surgery provides an excellent tool to limit the amount of food eaten and to change how food calories are absorbed. Not only is the stomach pouch too small to hold large amounts of food, but by skipping the duodenum, fat absorption is substantially reduced.
Since people who have gastric bypass can’t absorb fats, they lose weight faster than people who have the lap-band procedure. The gastric-bypass centers are quick to point this out in their literature. Just one little problem: you need fats. Your hair, skin, nails, hormones and bones depend on fats, either directly or indirectly.
As health writers like Sally Fallon and Nora Gedgaudas have pointed out in their books, many essential vitamins are fat-soluble, including A, B12, D, E and K. If you’re not absorbing fat, you’re also not absorbing and using those vitamins — even if you’re filling your itty-bitty pouch with supplements. And if you can’t absorb those vitamins, you also can’t fully absorb the nutrients that depend on them, like calcium. Here are some quotes I found from studies that examined the effects of gastric bypass surgery:
- The incidence of vitamin A deficiency was 69%, vitamin K deficiency 68%, and vitamin D deficiency 63% by the fourth year after surgery.
- The incidence of hypocalcemia (low calcium levels) increased from 15% to 48% over the study period.
- There is a progressive increase in the incidence and severity of hypovitaminemia (low vitamin levels) A, D, and K with time after biliopancreatic diversion and duodenal.
- Dolan et al. reported vitamin A deficiency in 61% of patients following biliopancreatic diversion at 28-month follow-up. This was despite an 80% compliance rate with multivitamin supplementation. (Read that again: most patients took their vitamin supplements, but still became vitamin A deficient.)
- Despite calcium and vitamin D supplementation after Roux-en-Y gastric bypass, Coates et al. found that within 3 to 9 months after surgery, patients have an increase in bone resorption associated with a decrease in bone mass.
So you end up losing weight, but also become vitamin deficient, and perhaps end up with brittle bones. I’d rather be fat and know I’m able to roll on the floor with my rambunctious girls without snapping a femur.
But of course, you don’t have to become vitamin deficient to lose weight. You can lose weight by cutting out sugar and starch, which don’t contain any nutrients we need – or to be more accurate, they don’t contain any nutrients we can’t get from the foods Mother Nature actually intended for humans to eat.
The lap-band procedure doesn’t block the internal absorption of fat, so it’s less likely to cause vitamin deficiency – and of course, the lap-band surgeons are quick to mention that advantage. But as you may recall from a previous post, you’re still limited to ridiculously small portions. I think it’s unlikely you can get all the nutrients you need from meals that could sit on a golf tee.
In fact, as I was wading through online research to write this post, I was reminded all over again of what an awful existence these procedures can produce. Here are some explanations of the post-surgical effects – and keep in mind, I pulled these from sites that are actually selling the procedures. Their explanations are in bullet points; my comments aren’t.
- What is Symptomatic Dumping Syndrome? Dumping is caused by rapid passage of food from the pouch into the small intestine. Before surgery, the stomach has a valve at the top and bottom, and serves as an acid-filled storage tank, breaking food intake down into small, component parts and passing it to the small bowel in increments. After surgery, food passes directly into the small bowel, mixed only with saliva and amylase from the mouth, but no stomach acid. The small bowel responds by diluting what we eat through a process of ‘water recruitment’ into the bowel space. This is referred to as ‘early dumping.’ Suddenly, the heart will pound and beat rapidly; you may feel dizzy, and overwhelmingly tired. The bowels may gurgle and churn, and will feel bloated and gassy. This might be followed by loose stools and even vomiting. It is not dangerous, but it can be frightening to the uneducated patient.
Yes, education is the key here. When I was in college, I saw lots of educated people dumping and vomiting at parties, but they were never overly concerned.
- Why is it sometimes necessary to vomit? Your pouch and Roux limb, the two parts of the gastric bypass tool, work like a slow moving sink drain. There is no stopper at the bottom of the sink, but the narrowness of the connection between the pouch and the Roux limb restricts the passage of food out of the pouch and into the Roux limb. Sometimes if a food gets stuck and will not pass into the Roux limb, the only solution is to cough out the offending food to release it from the pouch.
Coughing food out of your pouch … boy, that must make you popular at dinner parties.
- Why do some people complain of frothing after the surgery?
They actually gave one of those “it’s nothing to worry about” explanations, but I didn’t bother to copy it because 1) it was medical doublespeak, and 2) I was too busy laughing myself silly, picturing an obese, post-surgical woman frothing at the mouth … and her husband replaying the day’s events in his mind, trying to figure out what the heck he’d done wrong.
- What is Steatorrhea? Steatorrhea is the result of fat malabsorption. The hallmark of steatorrhea is the passage of pale, bulky, and malodorous stools. Such stools often float on top of the toilet water and are difficult to flush. Also, patients find floating oil droplets in the toilet following defecation.
So there you are, standing at the toilet, flushing and cursing and flushing and cursing and frothing at the mouth and risking a wrist fracture from all that yanking on the handle with your brittle bones, but your last meal insists on floating atop the water like a gang of pale, bulky, malodorous fishing bobbers. Sure, there are other options besides flushing, but they’re not pretty, even if you believe in composting. And to make matters worse, there are oil droplets floating around the bobbers. Best remember not to toss a burning cigarette butt into the bowl.
- If a LAP Band patient nibbles on food all day, he or she can continue eating a high-calorie, high-fat diet without ever feeling full and never lose weight.
Uh, no. If a lap-band patient nibbles on high-fat food, he or she will feel full. If he or she nibbles on carbohydrates, he or she will spike his or her insulin and then he or she will feel hungry and he or she will nibble again … and again … and again.
- Also note that hair loss is common – but don’t worry, it usually grows back within a year.
Which gives you plenty of time to color-coordinate your smaller clothes with your new wigs.
- If you are a regular coffee, tea, or soda drinker you should be aware that no caffeine is permitted for the first three months after surgery.
So I’ll be nice and thin when I’m sent to prison for aggravated assault. But I’ll also be bald, so maybe I’ll look badass enough to avoid any unwanted romances.
- Considering whether to undergo Lap Band surgery requires serious thought. It should only be considered if morbid obesity is a major medical issue and nothing has worked.
Really? I thought you should only consider lap-band surgery if you think dieting sucks.
- Remember, weight loss surgery is a tool!
So is the surgeon who performs it.