Carbonated Drinks and Weight Loss Surgery
August 11, 2012 3:56 pm
The consumption of carbonated drinks is discouraged after weight loss surgery. In fact, there is a wealth of information that documents the detrimental health effects of carbonated drinks for each individual. These include osteoporosis, obesity, and premature dental decay, just to name a few. Indirectly, carbonated drinks have been found to increase risk of stroke and Cardiac events. There are studies that show a 48% increase in heart attack and stroke rates for individuals who drink diet sodas vs. those who drink it rarely or not at all.
There is also no health benefit to diet carbonated drinks. In fact, there are animal studies that show that rats who consume no-calorie sweeteners found in diet sodas experience an increased appetite (Susan Swithers, PhD- 2004).
There are also other factors to consider. The carbonation comes from a mixture of dissolved gasses that are released when the container is opened. The Carbon Dioxide gas dissolved in the drinks, amongst others, can distend the stomach. Potentially, stretching your stomach. There is also acidity that needs to be corrected by the body. This has been shown to result in changes in the bacterial population in the GI track, resulting in significant bloating and reduced absorption of nutrients.
Calcium loss is caused by the leaching of the calcium from the bones with carbonated drinks, which can cause osteoporosis.
Nasal Methicillin Resistant Staphylococcus Aureus Predicts Site Infection In GI Surgery
August 06, 2012 12:27 am
Dr. Papaconstantinou of White Memorial Hospital in Temple, Texas has studied the relationship between the presence of colonized nares with Methicillin Resistant Staphylococcus Aureus (MRSA) and the incidence of the type of the infection after a gastrointestinal surgery.
He studied 1137 patients. He compared the postoperative infection rate of patients that were positive for MRSA, Negative for MRSA and a third group that was Methicillin Sensitive Staphylococcus Aureus (MSSA). He found that the infection rate for MRSA group was 14%, the highest of all the groups. There was no correlation however when other risk factors were accounted for.
The most significant finding however was the type of the infection present in MRSA patients. With positive nasal swab for MRSA, the most common organism causing the wound infection was MRSA (70%). In patients that were MRSA negative for the nasal swabs, the rate of MRSA wound infection was low at only 8.5%.
An additional finding was that the finding of MRSA positive nasal swab was a predictor for prolonged hospitalization.
There was no reported difference in the postoperative death rate in the MRSA positive or negative group.
It is important, however, to remind ourselves that this is a single study and more studies are needed to look at these variables in different surgical procedures.
The long-term outcome of the Adjustable Gastric Banding Esophageal Dilation after Gastric banding
July 07, 2012 12:35 am
The initial short-term data available for Adjustable Gastric Banding (AGB- Lap Band and Realize Band in the US) was promoted as a minimally invasive procedure with an equal outcome and low risk compared to the more commonly performed gastric bypass or the most successful procedure, the Duodenal Switch operation.
Over the years the data that has been published has drawn a completely different picture. The weight loss has not been as anticipated or sustained in majority of the patients who have had the AGB. Furthermore, the incidence of complication has been far worse than initially presented.
Common complaints that the patient reported with AGB includes inadequate weight loss, symptoms of reflux, abdominal pain, and significant solid or food intolerance. The general consensus and treatments have been tailored towards adjustment of the band either by adding fluid to tighten, to hopefully promote weight loss or by removing fluid from the band to reduce the restriction and resolving the reflux and/or deep abdominal pain. This only is after a mechanical or placement issue has been ruled out.
Most recently published data (Poster presentation ASMBS 2011 San Diego, CA.) shows that majority of the patients who developed esophageal dilatation, will require conversion to a different bariatric surgery. Furthermore, the consensus developing is that the placement of band should not be performed since there are better alternatives that can yield much better results with a safety profile that is better than that of the AGB.
As I have summarized previously, if long term data is reviewed the complication rate of the AGB is much higher that initially reported. I think there has been selective reporting of the data performed to promote a procedure that in the very short term may look attractive, however, over time, complications surface. Almost all patients with AGB procedures are sent home the same day, and in the first few months some weight is lost and almost no complication of reflux, indigestion, or other esophageal motility problems are reported. Yet when the same patient data is collected past the 12 months then there is increase in the reported cases of the complication of the banding procedures. This has lead to European and South American Centers that have lead the wave of the AGB placement to make a reversal of course and now recommend that other surgical procedures be offered to patients instead of the temporary fix of the AGB.
With our own practice we have significantly reduced the AGB placements. It is impossible to recommend a procedure that its results cannot be backed up with scientific data. We also find ourselves, spending a significant amount of time correcting the information that most patients have obtained from non-medical sources and even in some cases from other health care providers that is just not correct.
These are some of the examples of the information that I would like to clarify and explain to patients since they are deceiving and inaccurate.
“The band is reversible.”
Let’s take the concept of the “reversibility”. Can anyone name a procedure that a patient may need to have it done as a cure to an ailment with a condition of reversibility? Would anyone like to have a reversible hip replacement? Appendectomy? Or Cancer surgery? The point that I am raising is that the option of reversibility all by itself is not a meaningful measure other than it can be removed. One has to ask why I would want it removed. The answer is that it has a high complication rate that surface later on and in almost all cases requires band removal.
“It has minimal risk.”
The issue of the risk is one that I also emphasize. I think is inadequate to discuss the option of the risk in vacuum with no discussion of the benefits of each procedure. In majority of the cases patients indicate that the AGB can be done as outpatient (correct) with minimal down time (correct). The long-term outcome however is not there and I would recommend that the patient have no surgery since the long term complication of the banding is significant for any marginal benefit of weight loss.
“Patients have complications with the gastric stapling.”
There is a general misunderstanding that all procedures that have to do with weight loss are either the “gastric banding or the stapling type”. It is critical that we all appreciate that there are a number of different surgical procedures, that have different outcomes and each one of them needs to be examined for suitability for each patient
Bloating and Excessive Gas
April 17, 2012 7:36 am
The relationship between the consumption of food, bloating, and excessive gas is a subject that comes up frequently. In our practice, this is a complaint usually raised 3 or 4 years after receiving the duodenal switch operation. It appears that patients eventually disregard the recommendations made for a healthier diet of low carbohydrate, high protein, hydration, supplements, and then everything else.
In general, carbohydrates, carbonated drinks, artificial sweeteners (such as Splenda®, sugar alcohols, etc.), vegetables, excessive amounts of food, and an intake of fat will cause significant gas and bloating. This is not to be taken out of context and assumed that one cannot consume any of these products. However a diet that has fruits and vegetables will cause significant gas and bloating. These can not be controlled by probiotics, antibiotics, or other products such as Beano.
Simple carbohydrates/sugars (sugar, candy, cakes, cookies, pies, regular soda pop, jelly, jam, syrup, ice cream, sherbet, and sorbet, etc.) are easily absorbed. Simple carbohydrates/sugars can increase diarrhea due to the Duodenal Switch allowing more undigested sugars/fuel for intestinal bacteria to feed upon, multiply and form gas. The end result can be gas, bloating, and diarrhea.
Complex carbohydrates have more structure than simple carbohydrates/sugar which are harder for the intestinal bacteria to break down and may cause less bloating, gas and diarrhea. Also, complex carbohydrates usually contain higher fiber content. The fiber in the colon will help to absorb water from the stool and can reduce diarrhea. However, this is not the case for all Duodenal Switch patients.
When a patient reports these problems, I recommend that the consumption of all carbonated drinks should be stopped. No patient should consume carbonated drink of any sort. Artificial sweeteners should also be avoided all together. A good alternative would be honey, maple syrup or Stevia. Minimize or reduce the carbohydrate intake.
It has been our experience in the majority of cases that excessive gas and bloating is a result of dietary indiscretion. In some patients, once the dietary sources have been ruled out, it should be further evaluated by a barium enema to rule out the diagnoses of a redundant colon.
The best approach would be to first go back to a high protein and low carbohydrate. This should allow a patient to rule out any dietary sources for the bloating and excessive gas. It is recommended to next be seen by your physician for a further workup.
To summarize, when a patient has excessive amount of gas, diarrhea and bloating, the first line of treatment is elimination of all of the possible causes. These include carbohydrates, fruits, vegetables, artificial sweeteners, carbonated drinks and milk products. I can not overemphasize the importance of this step prior to anything else such as antibiotics or probiotics.
Feeding Jejunostomy TubeExclusive Member Content
February 06, 2012 3:38 am
Gastric Emptying after the Duodenal Switch and the Sleeve Gastrectomy
January 19, 2012 1:10 am
Gastric emptying time after Duodenal Switch and Sleeve Gastrectomy.
January 18, 2012 2:10 am
The gastric emptying is shorter after Duodenal Switch than after Sleeve Gastrectomy. This has been studied by having volunteers consume a known amount of measured food that contained trace amounts of medical nuclear markers. Using special imaging cameras, the amount of radiation collected in the stomach was measured over time. In the case of the Duodenal Switch patients, the emptying half time was 28 +/- 16 minutes, with the normal non-operated patient be at 91 +/- 20 minutes(i). The Gastric emptying after sleeve gastrectomy has been reported to be 38 +/- 19(ii) minutes and 57 +/-19(iii) minutes in two different studies.
(i) J. Hedberg et al., Gatric Emptying and Postprandial PYY resposnce after Biliopancreatic Diversion with Duodenal Switch. Obesity Surgery, (2001) 21:609-615.
(ii) Braghetto et al., Scintigraphic evaluation of gastric emptying in obese patients submitted to sleeve gastrectomy compared to normal subjects. Obesity Surgery, (2009); 19:1515-21
(iii) Bernstine et al. Gastric emptying is not affected by sleeve gastrectomy, without removal of the gastric antrum. Obesity Surgery, 2009;19:293-8.
Vitamin and Mineral Deficiencies
January 14, 2012 12:20 pm
Type 2 Diabetes Cure
January 14, 2012 9:22 am
Nutritional Deficiencies
January 14, 2012 8:23 am