Weight Loss Surgery Blog

Last week, the Food and Drug Administration (FDA) Advisory Panel overwhelmingly approved the new weight loss drug, Qnexa. Although recommended by the panel, Qnexa must still be approved by the FDA before it will become available. The target date for the FDA to review Qnexa is April 12th.

Qnexa is a combination of two drugs, phentermine and Topiramate. Phentermine is an appetite suppressant and Topiramate is an anti-seizure medication; however Topiramate has been used to counter-act the weight gain associated with anti depressants.

Qnexa has shown great promise in clinical trials. Of those taking the medication during the trials, patients have tended to lose approximately 10% of their body weight, which for a weight loss drug shows tremendous promise.

The approval of Qnexa is extremely important in the battle to help people get control of their weight. I know that most of you reading this have had or will soon have weight loss surgery. But that isn’t the answer for everyone. And the hope is to offer a choice of remedies so that people do not get to the point that weight loss surgery is their only option. Qnexa and other weight loss medications in the pipeline for FDA approval could hold that hope.

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A friend of mine just had gastric bypass surgery and was complaining that the popsicle she was eating had a terrible taste.  That immediately took me back a little more than 12 years ago when I had my surgery and had a similar complaint. Nothing tasted right, and I feared that nothing would taste right ever again. We all felt that way after surgery, “Is it always going to be this way?” Remember that scared feeling - what have we done?

We tell “newbies” that the strange coppery taste to food will pass and that food will eventually taste normal again. And that is true.  That awful coppery taste does go away. But what we never know is how our taste will change forever. There are certain things for me - and I’m sure for you - that are different than they were pre-op. Some things didn’t go away.

Something that I haven’t been able to overcome is a difficult time I have with protein. We know that we must eat protein, but I admit that I often have a hard time eating chicken, pork, and beef. I have totally given up pork.  It is just too dry for me.  As for chicken, I have to be so careful chewing.  I suppose I thought that my stoma (the opening between the pouch and intestines) would stretch and I would no longer have to worry about chewing meat to an absolute pulp, but nope. I still have to chew and chew.  I get bored chewing, and I definitely get impatient. I want to get on with things, not waste so much time chewing and chewing.  And if I try to abbreviate that chewing process, chances are that what I haven’t chewed enough will come up.

I also still suffer from dumping syndrome. After 12 years, there are times when I eat my share of sweets.  Again, if I overdo it, I feel nausea and sometimes shaking. My body tells me ,”No, no, no. You shouldn’t be eating that!”

The fact that I can’t cheat on chewing and still experience dumping syndrome is a testament to the staying power of weight loss surgery. I know I am really fortunate, but I know that there are a lot of people out there who go through the same thing. These inconveniences make maintaining weight so much easier. It amazes me that the medical community classifies dumping syndrome as a negative side effect. To me it is a blessing!

If you are several years post-op and still have symptoms like these, drop me an email and share it. I’d love to hear from you. 

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When you had your weight loss surgery you had one of two reactions - you either wanted to shout it from the roof tops and tell everyone you know, or you wanted to keep it very quiet and treat it as your own personal business.

Paula Dean recently announced that she has known that she has had diabetes for the past three years. While I have always believed that one’s personal health information can very well stay that - personal, it is evident over the past three years that Paula Dean’s actions could have been quite different without revealing her health condition.

A major cause of diabetes is obesity. And the way that Paula Dean cooks directly contributes to and promotes obesity. Ms Dean had an opportunity these past three years to use her popularity to promote a healthier way of eating, but she chose not to. She continued to promote her unhealthy practices to her millions of followers.

Paula has been the queen of grease, making recipes that promote obesity.

Sure all of us would love to eat those foods without consequences, but Paula’s ways caught up with her and she is now suffering those consequences.

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A reader asked:
I am nine years post-op from my gastric bypass surgery and have only put on 10 pounds over that time.  I am wondering if you could address the dangers or problems you know about aspartame as an artificial sweetener.  As a result of my surgery, I don’t drink any carbonated beverages or juice.  I am primarily drinking coffee, crystal light, water, tea and occasionally milk.  I seem to be able to go through a 2 qt pitcher on some days of the Crystal Light.  After reading about side effects, I find myself relating to the confusion, dizziness, nausea, depression and excessive thirst. 

Linda

Hi Linda,
I posed this question to Dr. Holly Lofton of New York University recently regarding the side effects that you describe; confusion, dizziness, nausea, depression and excessive thirst. Not everyone suffers those side effects. Some do, however.  Her approach is that if you have a sensitivity to aspartame, then you should avoid it.

Most diet sodas contain aspartame which studies have shown decreases the serotonin in the body.  Serotonin is the neurochemical that regulates emotions and appetite, among other things. Therefore a decrease in serotonin can cause depression which can lead us to turn to comfort foods as well as increase our appetite. So the diet soda that you are drinking may very well be making you more hungry and causing cravings.

A study from the University of Texas followed 600 people over an 8 year period. They found that of those who drank 1 to 2 cans of diet soda per day, 54% of them over the 8 year period became obese.  Those who drank 1 to 2 cans of regular soda, 33% of them became obese.

I am not suggesting and neither is the study that you should drink regular soda. And there is an argument to be made that the group drinking diet soda may have had a predisposition to obesity. However, this study is one more reason to consider how artificial sweetener acts in your body. 

There is some thought that drinking artificial sweetener signals the body that you will be getting sugar. When your body doesn’t get a true sweetener, the body starts to crave the sugar that it didn’t get. That might be why obesity is more prevalent.

Diet soda may not be the free ride that we think it is. There are side effects for those who are sensitive and what you think may be harmless may be contributing to weight gain. The studies are not definitive, but they should be enough to cause us to pause.

Just try going a week with no diet soda or artificially sweetened products and see if you notice a difference. Here are some substitutes for diet soda that you might want to consider

• Water – pure and simple
• Water with a little fruit juice mixed in
• Water with a slice of lemon or orange
• Herbal tea

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One of the many advantages of belonging to the Back on Track with Barbara program is that members can ask me questions and I will respond within 24 hours. If I can’t answer the question, I will find someone who can.  Another advantage is having access to the extensive library of teleseminars that I have done for the program. I had a member contact me as a result of both.

She had listened to a teleseminar that I had done with Dr. Jacqueline Jacques from Bariatric Advantage during which Dr. Jacques had mentioned having too high levels of vitamin B6.  This member had very high levels of B6 discovered through blood tests and she wondered how significant that was.

I contacted Dr. Jacques and to my surprise, she said that B6 toxicity is a real concern. She doesn’t see it often, but she has definitely seen it. But let me back up on this story just a little.

B6, also known as pyrndoxine, is a vitamin that is important in the utilization of protein. This is especially important to weight loss surgery patients because we need protein, plus we have absorption issues. Therefore not having enough B6 is not a good thing. B6 works with other B vitamins to boost our immune system. A lack of B6 can contribute to heart disease.  Therefore an adequate level of B6 is very important.

One would think that the more B6 you have, the better you would be able to absorb protein and fight off illness. But you can reach a point where more is worse and not better which is where the Back on Track member was.  Having too much B6 can cause nerve damage in the hands and feet.  It starts with a tingling sensation, a numbness or a burning feeling. These symptoms can also be present around the mouth. If the toxicity continues, serious coordination problems could develop. The symptoms usually disappear after the B6 levels comedown. But if B6 levels remain very high for a long period of time, the damage could be permanent.

The maximum amount of B6, 100 mg. per day, is usually present in any multivitamin. The problem is that it is very easy to exceed that number or if you have B6 levels that are very high, to eliminate B6 until you levels come down. B6 is everywhere. It is present in foods we commonly eat - beef, chicken, fish, beans, and bananas. Plus many protein drinks and sports drinks contain B6, as well as all multivitamins.

When having your lab work done (annually I hope) remember to have your B6 levels checked. If you have tingling in your hands and feet, please don’t assume that it is from B6 toxicity. Have blood work done to be sure.

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It’s a very common question, “After weight loss surgery, when can I start to eat normally again?” Those of us who have had weight loss surgery a few years ago know the answer - never! But of course it depends on what the definition of “normal eating” is.

My surgery was almost 12 years ago. I was fearful as I approached surgery that my eating days would be over. I love eating and I wondered if I would be able to enjoy a meal ever again. There is an incident that I talk about in my book, Weight Loss Surgery; Finding the Thin Person Hiding Inside You, in which I was sitting in the middle of a restaurant about three weeks before my surgery, eating a quesadilla, and I burst into tears. “I will never be able to eat a quesadilla again,” I wailed! Well I have eaten quesadillas since my surgery. But it comes down to how often and how much.

If “normal eating” means that you will resume your normal life and way of eating prior to surgery, you don’t want to go there. You don’t want to resume your normal life, because you don’t want to go right back to where you were prior to surgery. It is important to always remember your “bariatric roots.” You want to remember how bad you felt physically, how embarrassed you were to be seen in public, how low your self-esteem was as you failed one diet after another, how long your list of medications was, and all of the activities that you wanted to do and just couldn’t. All of those can help you to not go back to the way you ate before.

Anyone going through surgery must be willing to commit to living a healthy lifestyle – eating more sensibly and exercising. You may not be able to exercise prior to surgery, but as you lose weight, exercising should become more possible.  The first six months following surgery are not happy months in terms of eating. You start with a liquid diet and progress over a couple of weeks to full liquids, soft foods and then regular food.  There will be foods that you aren’t able to eat, because they won’t agree with you. They might feel like they are stuck when you eat them, or they might make you feel nauseated. For the most part that will pass.  Personally, being 12 years post-op, I eat out about two times per week.  If you saw me eating you would not know that I had surgery except for two things – I eat smaller meals and I chew food very thoroughly. I really don’t like chicken anymore. With the exception of chicken thighs, I find it too dry. If I eat too fast, I still will throw up. I cannot tolerate too many sweets. I can have a small piece of cake or pie or a cookie or two. More than that and I will get sick. 

There are rules that I have to follow (eat small meals, eat protein first, avoid carbohydrates, don’t drink while eating, minimal sweets, chew your food very well). If I follow these rules, I enjoy eating and it is much easier to maintain my weight.  It is the way I should be eating whether I had surgery or not. 

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I received an email recently asking a question about hunger, and the question sounded so familiar. What the reader stated was that she has a history of going on a diet, losing 50 or 60 pounds and then experiencing overwhelming, uncontrollable hunger that would cause her to go off her diet and regain weight. Yes, I remember that uncontrollable hunger all too well. It eventually wrecked almost every diet I ever tried. So where does that hunger come from?

The culprit is ghrelin, a hormone secreted in the  stomach and a small part of the small intestines that induces hunger. Research studies have found that the more ghrelin that is produced, the higher the body mass index (BMI) of the individual. So people who are obese have higher levels of ghrelin than those who are of normal weight.

Some studies have also found that ghrelin levels in those patients who have had gastric bypass surgery are lower than in those of the same weight that have not had surgery. Part of the reason may be that after gastric bypass surgery, there is less surface area in the stomach, therefore fewer cells in the working stomach to produce ghrelin.

You would think that there would be a vaccine that could be given to those who are overweight that would just block the production of ghrelin. Unfortunately it is not that simple.  Because eating and hunger are necessary for survival, the body seems to find other ways to induce hunger when ghrelin is blocked. So for now, we are stuck with it.

After gastric bypass surgery, those feelings of hunger are gone - at least for a few years. For many patients, the hunger returns, but generally it is not the overwhelming variety that plagued us before surgery. So if you are considering dieting because you over-indulged during the holidays, remember the following two points:

1. Don’t try a starvation diet.  That is a sure way for the extreme form of ghrelin-induced hunger to rear its ugly head. Your body’s instinct is to keep you from starving, so if you eat too small an amount, your body will rebel in many ways. One of them is to give you a jolt of real hunger.

2. A much better way to drop weight is to do it slowly through a lifestyle change. You will have a much better chance of long-lasting success. 

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My Mom died two years ago at the age of 95.  She lived with us the last nine years of her life, and all of us miss her terribly. So when I heard about the Presents for Patients Program here in Pittsburgh, I thought this would be a wonderful way to bring a little bit of my Mom’s presence back into our Christmas.

The program works by pairing people in the community with those who are in nursing homes.  You buy presents for them from a list that they have designated and deliver them during the Christmas season. I called immediately and asked for a female patients at a nursing home in my area.

My assignment arrived in the mail, and I was excited as I opened the instructions. I thought I could buy slippers like I would for my Mom or a nightgown or a book or a bright red amaryllis. My first clue that this was not going to be what I thought was the patient’s name - Megan. What older woman is named Megan? The suggested presents were a sweat shirt, pajamas, or stuffed animals. The instructions specified “no food.”

I called the nursing home to get a little more information, and I discovered that the patient indeed was not like my mother. Megan was a woman in her early 30’s. Although the nurse could not give me any details because of privacy laws, I did surmise that Megan had sustained a very serious head injury from an accident, was non-communicative, had a feeding tube, and would be living in a home for the rest of her life.

I was a little disappointed. I couldn’t go to the nursing home pretending  I was giving a gift to my Mom, but I was committed to going ahead with what I had promised. I talked further to the nurse and learned that Megan loves dogs. She suggested that I might want to bring her a poster of dogs. I then got an idea!

I have the most adorable dog, a little all white Maltese with big black eyes and a bouncy disposition. Munchkin is his name and he weighs only three pounds. He is not a teacup dog; he just never grew. He brings smiles to the faces of everyone who sees him.  So I asked if I could take Munchkin with me when I visited Megan. The nurse said she thought that Megan would like that.

So two days before Christmas, we visited Megan. As soon as we entered the nursing home, everyone started making a fuss over Munchie like they always do. We made our way to Megan’s room and there she was- lying there, not moving, staring in the direction of a window. We crossed the room and she didn’t make eye contact, even as we started to talk to her. I sat down on the side of the bed and lifted Munchie up on the bed to show her.

Although Megan didn’t really seem like anything registered with her, as soon as Munchie was on her bed, she started to glow. I looked down and somehow, in her curled fist, she had his leash and she was holding on. Munchie started to lick her fist and I told her that he was giving her kisses. That glow on her misshapen face spread over her and washed over me.  I felt such overwhelming happiness. And I understood.

This wasn’t my plan. My idea for this exercise was a somewhat selfish one, I admit it. I was doing this to make me feel good. But God had his own plan that was much different than mine. And when I saw that glow on Megan’s face, I understood God’s plan and appreciated his wisdom.

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I am often asked about revision surgery by people who have regained weight years after their original weight loss surgery. Revision surgery is a type of “do over” surgery that will either build upon the existing surgery or be an entirely new procedure that will help the patient lose the weight they have regained. If this is something you are thinking about, here are some things to think about. 

Before jumping into revision surgery, you should find out what caused your weight regain. If you originally lost a lot of weight, yet after years the weight returned, you are actually a good candidate for revision surgery. Those people who were never successful following weight loss surgery are much harder to find a successful path for. 

Facing the cause of your weight regain is a hard thing to do, but necessary so that you don’t keep repeating the same mistakes. You were able to maintain a weight loss for a number of years, so you should feel very proud of that, but what caused the weight to come back?  Let’s look at some of the possible factors:
1. Have you become lax and stopped following the basic rules of high protein, few carbohydrates,  and little snacking?
2. Is someone or some environment sabotaging your efforts?
3. Are there emotional issues that might be contributing to the weight regain that need to be addressed through counseling?
4. Are you more hungry than before? 

All of these need to be considered and taken very seriously.  If you are more hungry, your stoma (the opening between the pouch and the small intestines) might have stretched.  Revision surgery is not usually as effective as the first surgery that you had. Here are some of the revision surgeries that are done.
1. Assuming that you had gastric bypass surgery, a gastric band can be placed around the pouch to help you feel full and satisfied longer. This method has had some success. 
2. There is also surgery that will make the stoma smaller. One method is called the Stomaphyx in which a device is used that makes pleats to make the pouch smaller.  Another method is called scleroderma in which acid is used to form scar tissue on the stoma to make it smaller. Both of those methods have had limited success. 

There is also the issue of cost to consider. Revision surgery is about as expensive as the original surgery, about $15,000 to $25,000.  Insurance will not cover revision surgery unless your BMI is again over 40, making you severely obese. And even then, some insurance companies won’t cover revision surgery since it is a second surgery.  

Many surgeons won’t do revision surgery, because it is much more complicated to do. The surgeon must deal with the internal scar tissue that has been formed from the original surgery. It is not an easy thing to do. 

What you may want to consider rather than surgery is to try to control your weight on your own. Remember that diets don’t work. Years of dieting, losing weight and regaining the weight has taught us that. However, a change in your lifestyle by cutting out food that you know is not healthy and increasing your exercise does work.. It is a very slow process, but apart from surgery, is the most effective way to deal with weight regain.  

I would love to hear from anyone who has had revision surgery or from those who are thinking about it. 

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The gastric sleeve is a relatively new weight loss surgery procedure that is gaining in popularity. In the sleeve surgery, about 85% of the stomach is removed leaving the curved part of the stomach, that looks like a banana, intact. 

Food enters the stomach normally and exits normally as well. The patient is successful in their weight loss because with only 15% of the stomach remaining, the patient becomes full with less food.

The procedure has two important advantages:

1. There is no malabsorption. The intestines remain with no rerouting. therefore there is less chance of nutritional deficiencies than there is with the gastric bypass.

2. The pyloric valve remains. This valve is at the base of the stomach and regulates how fast food passes from the stomach into the intestines. With gastric bypass surgery, the surgeon tries to recreate a pyloric valve of sorts by making the stoma. The stoma is a narrow opening which keeps food in the pouch before it enters the small intestines. This stoma starts out the size of a dime, but can stretch over time making the gastric bypass surgery less effective because food leaves the pouch before the patient feels full and satisfied. With the gastric sleeve, there is no chance of stretching the pyloric valve.

There are two disadvantages:

1. Because 85% of the stomach is actually removed, the surgery is not reversible. Once you have the surgery, there is no going back.

2. Patients lose less weight with the gastric sleeve than they do with the gastric bypass.

There is a research trial being conducted at Northwest Weight Loss Center in Everett, WA currently concerning the gastric sleeve. Instead of removing 85% f the stomach, surgeons are folding the stomach over and stapling it, rather than removing it. This may eventually make the surgery reversible.

It is important to understand that no one surgery is the best weight loss surgery. Each one has advantages and disadvantages. However, choices are important. The more choices we have so that we can select the best surgery for ourselves, the more successful we will be.

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