Friday, September 10, 2010
New Video! Dietitian, Kristy Highley, RD Explains nutrition for Bariatric Surgery Patients
Kristy Highley is a Registered Dietitian with a Masters Degree in Nutritian. She is a licensed dietitian in the state of Ohio. She primarily works with patients in the Fresh Start Bariatrics program at Riverside Methodist Hospital, Columbus, Ohio.
Today I was thinking...
Among the 30 plus patients I saw in the office today was a wonderful couple who are supporting each other in their journey for better health through weight loss surgery. I operated on both the husband and wife last September (2009) just 2 weeks apart and are about 5 months out from surgery. They have already lost between 60 and 90 lbs each since surgery and much more since they began the Fresh Start Bariatrics program. They are both doing very well and are delighted with their progress. I am so impressed at how they encourage each other and look out for each other. They are both great examples and are taking advantage of all the program has to offer. It is so important to have a good support person as you go through this jouney. Their faith is important to them and is evident in how they treat each other and others here in the office. I told them I am excited to see where they are in their transformation next September one year after surgery!
Today I was thinking...
This morning I gave another Fresh Start seminar to prospective patients. I do this about 3-4 times a month and there are always interesting questions from the audience at the end. Today I met a delightful young woman who said, "I had a 'Gastric Stapling Procedure' back in the 1980s and I have gained my weight back. Am I was still a candidate for a Laparoscopic Gasstric Bypass?"
The procedure that is popularly known as "gastric stapling" is technically a vertical banded gastroplasty. This was an early attempt of Dr. Ed Mason in at the University of Iowa to help persons of size resolve their obesity and was used by many surgeons for a great many patients. The operation helped patients loose about 35% of their excess weight but the frequency of recurrence of obesity was very high. The operation created a small pouch of stomach below the junction of the esophagus and stomach with staples but left a small opening between the pouch and stomach open. A non-adjustable "band" was placed around this opening in an attempt to keep the opening from getting bigger. Unfortunately the band often failed to keep the restriction needed and would allow too much dilation over time. Also, since the pouch was in continuity with the rest of the stomach, any food that passed through the opening had no restriction and was absorbed normally. Of course, high calorie liquids would run right through the opening and would thwart the weight loss process and the patient could gain weight again. Also since the part of the stomach that produced the hormone, ghrelin, that makes us hungry for breakfast, lunch and dinner as not excluded from the flow of nutrients patients experienced no decrease in hunger. Also, since there was no opportunity to adjust the outlet of the pouch many patients did not feel restricted or their sense of restriction eventually went away and their obesity returned.
I told her, "Please do not 'beat up' on herself for gaining back her weight after the 'gastric stapling' because it was not a very successful operation and has been abandoned by nearly all bariatric surgeons since we have better techniques today." This was not a long term solution for most patients that had this procedure and as far as I am concerned I feel "failure" is nearly inevitable because it is the operation that failed the patients.
I further explained, "You can be converted to a Roux en-Y Gastric Bypass and usually I can do the operation laparoscopically even though your first operation was done open through a large incision." I have found this revision to be nearly as successful as the usual gastric bypass operation and have been very fortunate to have few complication after doing this revision but the risk of complications such as a staple line leak are reported as higher than if this was the first operation on the stomach.
She was excited about this possibility and is looking forward to starting the process. I feel she has every right to feel this revision could help her find a better long term solution for her obesity and I would be honored to be part of her transformation.
The procedure that is popularly known as "gastric stapling" is technically a vertical banded gastroplasty. This was an early attempt of Dr. Ed Mason in at the University of Iowa to help persons of size resolve their obesity and was used by many surgeons for a great many patients. The operation helped patients loose about 35% of their excess weight but the frequency of recurrence of obesity was very high. The operation created a small pouch of stomach below the junction of the esophagus and stomach with staples but left a small opening between the pouch and stomach open. A non-adjustable "band" was placed around this opening in an attempt to keep the opening from getting bigger. Unfortunately the band often failed to keep the restriction needed and would allow too much dilation over time. Also, since the pouch was in continuity with the rest of the stomach, any food that passed through the opening had no restriction and was absorbed normally. Of course, high calorie liquids would run right through the opening and would thwart the weight loss process and the patient could gain weight again. Also since the part of the stomach that produced the hormone, ghrelin, that makes us hungry for breakfast, lunch and dinner as not excluded from the flow of nutrients patients experienced no decrease in hunger. Also, since there was no opportunity to adjust the outlet of the pouch many patients did not feel restricted or their sense of restriction eventually went away and their obesity returned.
I told her, "Please do not 'beat up' on herself for gaining back her weight after the 'gastric stapling' because it was not a very successful operation and has been abandoned by nearly all bariatric surgeons since we have better techniques today." This was not a long term solution for most patients that had this procedure and as far as I am concerned I feel "failure" is nearly inevitable because it is the operation that failed the patients.
I further explained, "You can be converted to a Roux en-Y Gastric Bypass and usually I can do the operation laparoscopically even though your first operation was done open through a large incision." I have found this revision to be nearly as successful as the usual gastric bypass operation and have been very fortunate to have few complication after doing this revision but the risk of complications such as a staple line leak are reported as higher than if this was the first operation on the stomach.
She was excited about this possibility and is looking forward to starting the process. I feel she has every right to feel this revision could help her find a better long term solution for her obesity and I would be honored to be part of her transformation.
"Which Operation do I choose to resolve my Type 2 Diabetes?"
This question comes up often when a new patient is interested in the Fresh Start Bariatric Program. At least 25% of our patients have Type 2 Diabetes. If your goal is to resolve Type 2 Diabetes, the most effective tools is a Roux en-Y gastric bypass. In fact 95% of patients that have had Type 2 Diabetes for less then 5 years, will have no evidence of Type 2 Diabetes following this operation. A gastric sleeve procedure is somewhat less effective and an adjustable gastric band operation is even less effective in resolving Type 2 Diabetes. Overall, 84% of patients who have Type 2 Diabetes have remission of their diabetes.
A patient's Success Story - Improving Diabetes - Don Swonger
The following videos are of Don Swonger telling of the changes in his life since his laporoscopic Roux en-Y Gastric Bypass as of a year ago.
Part 1
Part 2
How do you think a gastric bypass helps to resolve Type II Diabetes?
Over 80% of Type II Diabetics show no evidence of diabetes after a gastric bypass operation. If a person has had diabetes for less than 5 years 95% of these people have no evidence of diabetes after this operation. Although we are still working out the reasons why this occurs, I believe Diabetes is improved or resolved in a three staged sequence.
1). Early after the operation carbohydrate intake is minimal so the glucose level remains low. In fact in our practice I have patients on a very low carbohydrate diet for 1 to 2 weeks before surgery and frequently they no longer need their diabetic medicines even before surgery as long as they continue to consume very few carbohydrates. The reduction in the amount of carbohydrates consumed is clearly an important component in this process that continues even after their operation since it takes several weeks or a few months for the amount of carbohydrate a person consumes increases and stabilizes at a new lower amount.
2). A second component that helps the diabetic is the hormone change that occurs after a gastric bypass. Probably the most important of these changes is the increase in a hormone like substance from the last part of the small intestine and the first part of the large intestine called GPL-1 (Glucagon Like Polypeptide-1) which increases the amount of insulin a gastric bypass patient sends into the blood stream from their pancreas. This begins immediately after the operation and is part of the reason that most diabetics do not need further diabetic medicines by the time they leave the hospital after their operation.
3). Finally, since obesity is the most important reason most of our patients develop diabetes, losing weight and keeping it off decreases the obesity and the patients lose their resistance to insulin. Therefore the amount of insulin they are able to make is enough to keep their glucose in the right range. Unlike the previous two components that decrease the blood sugar right after surgery this component takes time to show the beneficial effect of weight loss but by the time the patient is able to consume a more normal amount of starch and sugar he or she has lost enough weight to no longer need their diabetic medicines because of the loss of insulin resistance from the resolution of their obesity. This is why with some patients we need to slowly decrease the amount of diabetic medicine they are on over several weeks or even a few months.
It is important to understand that not everyone will have resolution from their diabetes. About 15 to 20 percent will still need to be on some diabetic medicines after a gastric bypass operation. The longer a person has type II diabetes the less likely it is that they will resolve their disease. However I have seen some patients resolve their diabetes after a gastric bypass operation even after 10 or 15 years of diabetes. Nevertheless even if the diabetes is not completely resolved it is much easier to manage and usually a person needs to be only on a pill they can take by mouth and they will not need to take insulin shots.
Recently I have been hearing from our patients that their endocrinologist is encouraging them to investigate bariatric surgery early after a new diagnosis of type II diabetes so it is more likely that they will resolve the disease instead of waiting for years until they have sustained injury to other organs. This is an amazing change in the attitudes of endocrinologists and I believe it represents a great opportunity for people with diabetes.
And to think I have the privilege of helping people in this way! How cool is that?
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1). Early after the operation carbohydrate intake is minimal so the glucose level remains low. In fact in our practice I have patients on a very low carbohydrate diet for 1 to 2 weeks before surgery and frequently they no longer need their diabetic medicines even before surgery as long as they continue to consume very few carbohydrates. The reduction in the amount of carbohydrates consumed is clearly an important component in this process that continues even after their operation since it takes several weeks or a few months for the amount of carbohydrate a person consumes increases and stabilizes at a new lower amount.
2). A second component that helps the diabetic is the hormone change that occurs after a gastric bypass. Probably the most important of these changes is the increase in a hormone like substance from the last part of the small intestine and the first part of the large intestine called GPL-1 (Glucagon Like Polypeptide-1) which increases the amount of insulin a gastric bypass patient sends into the blood stream from their pancreas. This begins immediately after the operation and is part of the reason that most diabetics do not need further diabetic medicines by the time they leave the hospital after their operation.
3). Finally, since obesity is the most important reason most of our patients develop diabetes, losing weight and keeping it off decreases the obesity and the patients lose their resistance to insulin. Therefore the amount of insulin they are able to make is enough to keep their glucose in the right range. Unlike the previous two components that decrease the blood sugar right after surgery this component takes time to show the beneficial effect of weight loss but by the time the patient is able to consume a more normal amount of starch and sugar he or she has lost enough weight to no longer need their diabetic medicines because of the loss of insulin resistance from the resolution of their obesity. This is why with some patients we need to slowly decrease the amount of diabetic medicine they are on over several weeks or even a few months.
It is important to understand that not everyone will have resolution from their diabetes. About 15 to 20 percent will still need to be on some diabetic medicines after a gastric bypass operation. The longer a person has type II diabetes the less likely it is that they will resolve their disease. However I have seen some patients resolve their diabetes after a gastric bypass operation even after 10 or 15 years of diabetes. Nevertheless even if the diabetes is not completely resolved it is much easier to manage and usually a person needs to be only on a pill they can take by mouth and they will not need to take insulin shots.
Recently I have been hearing from our patients that their endocrinologist is encouraging them to investigate bariatric surgery early after a new diagnosis of type II diabetes so it is more likely that they will resolve the disease instead of waiting for years until they have sustained injury to other organs. This is an amazing change in the attitudes of endocrinologists and I believe it represents a great opportunity for people with diabetes.
And to think I have the privilege of helping people in this way! How cool is that?
Want to make a comment or ask your question? Click on the word ”comments” at the end of this posting.
Want to have new postings I make to this blog sent free and automatically to your email? It takes less than 30 seconds. 1). Enter your email address where requested on the left side of this blog.2) Click on “subscribe” and follow directions to prevent spam.3). Click on “Complete Subscription Request”. It’s just that easy! Your email will not be shared or used for any other contact.
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