GASTRIC BYPASS

Gastric bypass surgery

Gastric bypass is the most frequently performed weight loss procedure in the United States of America.

Combined gastric bypass surgery is called “combined” because not only the size of the stomach but also the length of the gastrointestinal tract is reduced. A small pouch (15–30 ml in volume) is formed from the upper part of the stomach.

Gastric bypass is performed under general anesthesia, using minimally invasive laparoscopic approach.

The size of the stomach is reduced by almost 90 %*, therefore onetime food intake capacity decreases significantly, and the patient feels early sensation of fullness. Normally, food passes from the stomach into the small intestine which absorbs major proportion of nutrients as well as calories. The remaining food further passes into the large intestine. During the gastric bypass surgery, reduced stomach is connected directly to the middle part of the small intestine, thus bypassing the remaining gastric body and the upper part of the small intestine (duodenum). The procedure shortens the “path” of food through the gastrointestinal tract, and therefore less of it is absorbed. The extent of intestinal “bypass” is chosen according to patient’s BMI.

Possible complications specific to gastric bypass surgery

An anastomosis is a surgical connection between an intestine and the stomach or between two intestinal parts using special staples or sutures. Due to inappropriate healing of such connections, following complications are possible:

  • Anastomotic leakage. This causes leakage of fluid from the gastrointestinal tract into the abdominal cavity and subsequent infection. Such complication occurs in 2 % cases, more often in the area of gastrointestinal anastomosis. Anastomotic leakage is usually treated with antibiotics. However, additional operation may be necessary.
  • Anastomotic stricture. During the healing process of the anastomosis, scar tissue forms in that area. It normally recedes and only slightly narrows the diameter of the affected part of the gastrointestinal tract.  However, in some cases excessive scarring may narrow intestinal diameter significantly and even disturb passage of liquid materials. Such condition may be corrected during a gastro-endoscopic procedure in which the stricture is dilated using a special balloon.
  • Ulceration of the anastomosis. Occurs in 1–16 % cases. Causes of ulceration include insufficient circulation of the anastomosis, tension, increased gastric acidity, use of non-steroid anti-inflammatory drugs. This condition is treated conservatively – medications, special diet are used.
  • Gastric dumping syndrome. If lots of carbohydrates are ingested, they pass directly into the small intestine. Subsequently, the organism secretes large amounts of fluid into the intestine to dilute excessive sugars. The patient may therefore feel abnormal heart beating, cold sweating, strange sensations in the stomach and anxiety. Such state may last for up to 45 minutes and is often accompanied by diarrhea.
  • Lack of particular nutrients, minerals and vitamins. To avoid such complications, well-balanced nutrition and food supplements are highly recommended postoperatively. Hyperparathyroidism may develop due to inadequate absorption of calcium.

Gastric bypass efficiency

Studies show that gastric bypass surgery helps patients lose from 65 % to 80 % of their overweight. Moreover, significant decrease in associated co-morbidities is observed:

  • Correction of hyperlipidemia and hypertension in more than 70 % cases
  • Improvement of obstructive sleep apnea
  • Correction of type II diabetes mellitus in more than 80 % of cases
  • Recovery from gastroesophageal reflux disease
  • 89 % decrease in overall mortality

Recommendations for patients

Patient’s cooperation and correction of his / her nutritional habits is essentialafter restrictive adjustable gastric banding surgery as well as after combined gastric bypass surgery. From 5 to 6 meals per day are recommended, snacks should be strictly avoided. Patients should chew their food well, their bites should be small and they should stop using particular products. Non-adherence to aforementioned recommendations may cause various complications and furthermore, desired weight loss may not be achieved.

Gastric Bypass: Advantages & Disadvantages*

*Please note that each case is individual and the results may vary.

Growing problem of obesity

Obesity is a common health condition rapidly increasing around the world. It is a complex issue that also encompasses biological, physical, psychological and social aspects. In general terms, obesity is the condition in which the weight of a person reaches a certain level when it starts to seriously affect health, causing chronic and ultimately life-threatening disorders. Excess weight is a well-known risk factor for the development of coronary heart disease, respiratory failure, diabetes mellitus, dyslipidemia, hypertension, joint degeneration and cancer. The risk of death among women with a body-mass index of 32 or greater is twice as higher than among women who are not overweight.

Who should consider gastric bypass?

When conventional approaches of dietary restrictions and exercise programmes do not help to achieve substantial long-term weight loss, gastric surgeries are recommended. When even the most modern pharmacological methods are unable to produce the desired results, surgery can help attain what is otherwise unattainable. Among the weight loss surgeries so far gastric bypass is showing the best results. It is the most successful way to help patients with severe obesity because of its safety, low morbidity and very low mortality, as well as the ability to reach remission of serious medical conditions related to obesity.

Gastric bypass surgery is usually performed laparoscopically. Laparoscopic gastric bypass surgery is a technically challenging operation. During the surgery, the proximal stomach is separated from the distal stomach to form a small, restrictive gastric pouch. Gastric bypass alters the way in which the human body digests food. This type of surgery works by restriction and malabsorbtion. Patients after gastric bypass surgery experience early satiety and, consequently, eat smaller meals, therefore, their weight starts decreasing.

Advantages of gastric bypass surgery

Laparoscopic gastric bypass surgery is a purely restrictive intervention. It is also minimally aggressive and reversible. It is the most commonly performed weight reduction operation. Gastric bypass is generally regarded as the gold standard operation and is reported to achieve greater weight loss with greater reliability. The long term results show average 60 % to 70 % of excess body weight loss. Weight is likely to fall for up to 10 years.

As body weight goes down, many health issues associated with morbid obesity improve or even get resolved. For instance, sleep apnea, gastro-esophageal reflux disease, heartburn, urinary stress incontinence, and the functioning of the respiratory tract. Studies showed that gastric bypass reduces the risk of heart attack.

Patients with diabetes mellitus require less medication and manage it a lot better. Dyslipidemia, particularly hypertriglyceridemia and elevated cholesterol/HDL cholesterol are also resolved much more reliably and impressively than with any medication. Also it has been found that about 60% or more patients are able to go off medications for high blood pressure problems after gastric bypass surgery.

Gastric bypass surgery is also a relatively safe procedure even for older patients and patients with known cardiovascular disease. The laparoscopic gastric bypass surgery shows good results in short postoperative pain, short length of hospital stay, quick return to work and other activities of daily living, and a rare rate and severity of wound infections.

Patients who undergo bariatric surgery successfully achieve substantial weight loss, improve quality of life and report about good health in general. The combination of these changes has a tremendous impact on life expectancy of the severely obese patients.

Disadvantages of gastric bypass surgery

Despite the significant benefits of gastric bypass surgery, certain systemic and surgical complications are associated with this type of surgery.  Most bariatric patients have significant co morbidity, increasing their risk of postoperative cardiopulmonary complications which can cause difficulties during the surgery.

Apart from technical complications, cardiopulmonary and wound-related complications are the most common and most severe and can lead to cardiovascular accidents, myocardial infarction, pulmonary embolism, respiratory failure and others.

About 10 percent of all patients have postoperative complications such as bleeding from the  gastrointestinal tract, strictures, obstructions, ulcers, gallstones, urinary tract infection and other issues like nutritional deficiencies in getting enough folic acid, thiamine, calcium, zinc, vitamin B12, vitamin D, vitamin A and iron. It may lead to anemia, encephalopathy and other disorders.

Patients with addictive behaviour, such as alcohol abuse and active cigarette smoking fall into the group of increased risk for complications. They often fail to stick to their diet and medical instructions, therefore the risk of poor weight loss and complications is exceptionally high.

Patients who had a dependence on food before the surgery, may suffer from addiction transfer, potentially trading a food addiction to alcohol or drugs abuse problem. All these issues may lead to weight regain and ground for reoperation.

Solution to obesity

Obese patients represent a unique part of population with important anatomical and physiological problems that can influence the surgery outcome. However, it is still possible to achieve optimal health after gastric bypass. Gastric bypass surgery decreases the risk of all-cause mortality and cardiovascular mortality in obese patients. Bariatric surgery is followed by substantial and durable weight loss and is associated with favourable metabolic effects far beyond those achieved by lifestyle modifications and pharmacological treatments. As a result, gastric bypass may improve or even resolve diabetes mellitus, hypertension, sleep apnea and dyslipidemia.

All patients should be carefully screened before the surgery and all postoperative patients need a constant monitoring by doctor to check for other potential problems.

Lifestyle Changes After Gastric Bypass*

*Please note that each case is individual and the results may vary.

Overweight and obesity are major worldwide health problems. Nowadays there is a huge selection of traditional weight loss therapies, such as low-energy diets, different types of exercises, behaviour therapy and modification, pharmacological treatment and other methods.

Unfortunately, clinically severely obese patients respond poorly to traditional diets and exercise and have limited success. Even when an initial response occurs, it is likely to be poorly maintained. While many people achieve some weight loss initially, the majority fails to maintain the reduced body weight in the long run. In these situations gastric bypass surgery is a well-accepted solution and is the mainstay of surgical therapy for the treatment of obesity and, compared to conventional weight loss methods (e.g., diet, exercise), results in considerable and long-term weight loss. Currently, several bariatric surgeries are performed around the world, including vertical banded gastroplasty, gastric bandingsleeve gastrectomy, biliopancreatic diversion, duodenal switch, and Roux-en-Y gastric bypass.

Education

After gastric bypass surgery weight loss is achieved because the size of the stomach is reduced during the surgery. Short-term studies (3 to 5 years) show that a person loses from 40% to 80% of excess weight after bariatric surgery, whereas long-term studies (>10-year follow-up) indicate that loss of excess weight after the surgery varies from 50% to 80%, depending on the surgical technique used.

However, in order to achieve a certain goal surgery alone is not enough. That is why before and after the surgical treatment patients are educated extensively about the surgery, complications, predictions and outcomes. Typically they also undergo counseling with a dietitian and surgeon. They get acquainted with possible psychosocial issues and the required pre-surgical and post-surgical behavioural changes.

Dietary changes

The most important and rather difficult change in lifestyle for the majority of patients is dieting. The new gastrointestinal anatomy created by the surgeons is designed to accommodate only small amounts of food. That is why patients must change their meal portion sizes. Also, the new gastrointestinal tract requires some changes in digestion and absorption, that is why meals should be rich in protein, fiber, vitamins, minerals and other nutrients and regular monitoring of iron, vitamin B12 and blood count is recommended.

Physical activity

In addition to the recommendations for dietary changes, exercises should become a routine component in the patients’ lives after surgery. It helps to reduce weight and reduce the risk of coronary heart disease, stroketype 2 diabeteshypertension and colon cancer, which are common among obese patients. Moreover, after long-term obesity, the muscles and joints are damaged, that is why physical therapists should instruct, monitor, and educate the patients about the importance of exercise, including mode, frequency, and intensity of activity for cardiovascular fitness, muscle strength, and endurance.

Sexual activity

Obese patients usually are depressed because of their inactivity and discrimination. However, after bariatric surgery and weight loss they regain sexual interest, the enjoyment and frequency of it increases. After surgery sexual satisfaction increases, which means that the overall satisfaction with life and the surgery outcome grow.

Co-morbidities

Obesity is associated with fair or poor health and plenty of diseases. Bariatric surgery has a great impact on these co morbidities.  Even a small weight loss improves type 2 diabetes, dyslipidemia, hypertension, joint pain, sleep apnea and leads to an improved long-term control of these same conditions.

Medication usage

Studies show that people use fewer medications to alleviate co morbidities after obesity surgery. For instance, people taking mmedication for diabetes reported a reduction by 72%. Subjects with depression also noted a marked reduction in medication usage by 50%. Medication usage for other obesity-related conditions such as hypertension, hyperlipidemia, and arthritis were also significantly reduced. Such major reduction in medication usage for obesity-related conditions positively impacts the budgets of individuals, insurance companies and other institutions.

Gastric Bypass And Pregnancy

Gastric bypass is one of the most commonly performed weight reduction surgeries in the world. The obesity rate is growing dramatically. Obesity is characterized by a state of hyperinsulinism, hyperandrogenism, dyslipidaemia, hypertension and polycystic ovary syndrome, leading to amenorrhoea and infertility.

Obesity impairs fertility

Weight loss can change the mechanism of fertility. Women who suffer from morbid obesity are often infertile.  Even if an obese woman is able to get pregnant, it is still considered as high risk because of the obesity complications for the baby such as macrosomia, preeclampsia, miscarriage, gestational diabetes, pregnancy-induced hypertension, labour induction, Caesarean section, birth defects, post-partum weight retention, juvenile obesity and other associated risks.

Gastric surgery to overcome obesity

Gastric bypass surgery is a type of bariatric weight loss surgery that makes the stomach smaller and allows food to bypass parts of the digestive system, thus reducing the amount of calories a person absorbs and restricting the amount of calories a person can consume. This means that a patient eats less because he or she feels full quickly and some of the food will not be fully digested. Gastric surgery helps to fight obesity.

Roughly half of all gastric bypass surgery patients are women of reproductive age. Gastric bypass surgery is the safest and the most effective method of weight loss for obese women of childbearing age, with preferential outcomes for pregnancies after surgery.

Gastric bypass may protect women and baby from obesity-related issues

Large numbers of women in their reproductive age may undergo bariatric surgery, which may change fertility following weight loss. Pregnancy after bariatric surgery is not only safe for mother and baby but may also be less risky and might protect obese women and their babies from obesity-related problems and complications during and after pregnancy. Babies born to women who had gastric bypass surgery have just as much of a chance at being perfectly healthy as babies born to other women. Patients understanding the mechanism of weight loss surgery can  help to prevent nutrition-related complications and improve maternal and fetal health, in this high-risk obstetric population and it is key for as successful surgery outcome.

Possible risks

Complications specific to gastric bypass surgery may include hyperemesis, bleeding from gastrointestinal tract or wound, anastomotic leak, gastric perforation, nutritional deficiencies, anastomotic stricture, internal hernia, wound infection, heart attack and others.

However, this intervention involves certain changes in the digestive process and physiology and is the source of nutritional and metabolic complications. People who have undergone gastric bypass surgery often have nutritional deficiencies in getting enough folic acid, thiamine, calcium, zinc, vitamin B12, vitamin D, vitamin A and iron.

Mothers who have undergone gastric bypass surgery having lack of nutrition can become a serious problem to babies growing in their womb. Gastric bypass surgery may potentially lead to fetal complications, including preterm birth, low birth weight, fetal mental retardation, neonatal hypocalcemia or rickets, maternal osteomalacia, and neural tube defects.

Anemia can be secondary to iron deficiency, folic acid deficiency and even to vitamin B12 deficiency. Neurological disorders such as Gayet-Wernicke encephalopathy due to thiamine deficiency, or peripheral neuropathies may also be observed.

Complications such as bone demineralization due to vitamin D and calcium deficiency, hair loss secondary to zinc deficiency or hemeralopia from vitamin A deficiency may occur.

After gastric surgery it is recommended to wait approximately 12-18 months before becoming pregnant until the woman’s weight stabilizes. This delay helps to avoid most of the potential nutritional complications for a pregnant woman and her baby.

Before and after gastric bypass

Preoperative assessment and selection should be performed by a multidisciplinary team to obtain optimal results after surgery. The nutritional status of the woman after gastric bypass surgery and during her pregnancy should be closely monitored. Weight changes during pregnancy during the postpartum period should be followed in an effort to maximize weight loss and ensure fetal health. Prenatal care is best accomplished with careful coordination between the obstetrician and the bariatric surgeon.

Gastric Bypass And Diabetes*

*Please note that each case is individual and the results may vary.

Recently the medical community has been busy discussing the effect that gastric bypass has on treating type 2 diabetes in more detail. At the same time, more and more doctors and patients became interested in this process.

Defining gastric bypass

Gastric bypass surgery is an efficient weight-loss treatment for patients with morbid obesity. The procedure limits the food intake and restricts the absorption of calories by diminishing the size of the stomach and modifying the flow of food into the duodenum. Although the resulting weight-loss may work against diabetes, endocrinologists remark better blood-sugar control and less significant symptoms well before patients start to lose weight. Six years after surgery 62% of patients report about the remission of type 2 diabetes.

How can gastric bypass alleviate type 2 diabetes?

How does weight loss surgery work for patients with type 2 diabetes? There are no clear answers yet but doctors are carrying out an ongoing research. For instance, a recent study of more than 600 patients showed that 78 % of people had a total resolution of their diabetes after the procedure.

So far bypass surgeries proved to be more efficient than the surgeries that only “tighten” the stomach. Although blood glucose levels are likely to decrease with any kind of weight loss, the improvement after the surgery appears surprisingly quickly. This may have something to do with the reconfigured anatomy but scientists are not too certain whether it is due to the GLP-1 hormone, the inhibition of an agent that stimulates the appearance of high blood glucose, or the reduced calorie intake.

Looking closer at amino acids

Two American Diabetes Association-sponsored scientists have revealed probable clues that can help clarify why weight loss surgery improves the medical condition of diabetes 2.  In previous research scientists found that enhanced circulating amounts of particular types of amino acids (the building-blocks of proteins) are connected to insulin resistance and cardiovascular disorders. Now in a more recent research scientists notified that patients who had undergone weight loss surgery have significantly decreased amounts of these amino acids circulating in their bodies.

Study: blood-sugar levels down after weight loss surgery

Research involved 21 obese people diagnosed with type 2 diabetes, 10 of them had weight loss surgery while the others went on a 1,000-calorie meal-replacement diet per day. All individuals lost equal amounts of weight, but those who followed the diet took about a month longer to do so and had bigger amounts of the amino acids in their bodies than the people who had weight loss surgery. They experienced a significant decrease of their blood-sugar levels and were capable of discontinuing their diabetes medications entirely within one month of the surgery, while a few of the dieters still required their medication despite the same weight loss.

Progress in diabetes treatment expected

Scientists decided to concentrate on the impact of these amino acids on diabetes in the upcoming studies. They are optimistic that their previous discoveries may lead to a progress in new diabetes treatment research that would be as efficient as weight loss surgery. It is in particular relevant because some of the patients with type 2 diabetes do not qualify for the procedure. In Europe the surgery is offered only to individuals with a body mass index (BMI) of at least 30. The American Diabetes Association presently advises considering weight loss surgery for patients with type 2 diabetes who have a body mass index (BMI) of 35.

Although the time-tested gold standard for diabetes treatment remains dieting, sports and medications, weight loss surgery can be a thrilling option for the obese patients with type 2 diabetes.

Gastric Bypass And Hypertension*

*Please note that each case is individual and the results may vary.

Gastric bypass procedure is one of several weight loss surgery techniques used to treat obesity. During this procedure the stomach is divided into two pouches and the upper one is connected with a loop of small intestine. Thus the actual volume of stomach receiving food and the length of the small intestine participating in the digestion process is reduced. This gastric procedure raised a lot of discussions about whether bariatric surgery could actually be effective in treating co-morbidities of obesity, such as hypertension.

Hypertension

Hypertension is a common condition among middle-aged and elderly people. It is attributed to a list of so-called “Lifestyle diseases”, or “Diseases of civilization” along with other morbidities such as type 2 diabetes mellitus, atherosclerosis, metabolic syndrome, heart disease, cancer, obesity and others. Many of these diseases share the same or very similar pathogenic pathways and therefore are related; very often they go together or are the cause of one another. Hypertension is also known as “the silent killer” as it usually has no symptoms but due to severe late complications hypertension has a substantial effect on the overall quality of life. It also increases mortality rates. Persistent hypertension is an independent predisposing factor for a stroke, heart, kidney and eye diseases.

Link between obesity and hypertension

The impact of obesity and hypertension on public health is increasing worldwide. According to studies, obese people are prone to hypertension and vice versa. Although not all underlying pathophysiologic mechanisms are clarified, it is known that overweight and obesity are related to an activation of sympathetic nervous system, impaired kidney function, artery wall thickening and certain changes in the hormonal system, regulating blood pressure. Altogether these factors contribute to an increase in blood pressure, which then independently affects target organs.

The link between obesity and hypertension is well established. Furthermore, studies also have shown that there is a reverse dependence between body weight and blood pressure: whilst reducing the former, simultaneously better control of the latter is achieved.

 

Bariatric surgery improves hypertension

Interestingly, the same positive effect on hypertension control was obtained after a multitude of various bariatric surgeries, including gastric bypass. According to one study, almost a half of the gastric bypass procedure patients had complete resolution of hypertension at 12 months follow-up and in addition to that, another20 percent had significant improvement. Such results are quite remarkable, considering that hypertension is generally a chronic disease, requiring a lifelong treatment.

Gastric Bypass And The Risk Of Heart Attack*

*Please note that each case is individual and the results may vary.

Cardiovascular disorders are the leading causes of death and heart attack, with obesity as the leading risk factor. Obesity and overweight have already become a global and constantly growing problem. Weight reduction is an important though quite a tough task. Diet and exercise can work for some patients, while for the others it does not.  Individuals, who are severely obese, with a body mass index over 30, usually need additional help for weight loss to be more effective.  Gastric bypass, also called stomach-stapling is the most popular,effective and long lasting treatment for morbid obesity and many related conditions.

Gastric bypass technique

More than 340,000stomach-reduction surgeries are performed each year in the world. During the surgery a surgeon makes the stomach smaller and attaches it to the lower part of the intestine creating a small opening for food to pass through. The part responsible for the basic steps of digestion and absorption is bypassed, which leads to reduced amount of food taken into the bloodstream. After gastric bypass surgery patients experience early satiety and, consequently, eat smaller meals. As a result, the formation of fat tissue decreases.

Health issues due to excess weight

Based on weight alone, obese people have twice the risk of developing cardiovascular diseases and death compared to normal weight people. Cardiovascular risk factors develop progressively with an increase in weight. Moreover, it is known that obesity is often accompanied by metabolic syndrome, also known as the insulin resistance syndrome which constitutes a constellation of metabolic abnormalities including glucose intolerance, hyperinsulinemia, dyslipidemia and hypertension. Clearly, high amounts of cholesterol, triglycerides and abnormal concentrations of lipids and lipoproteins are closely associated with premature and accelerated coronary atherosclerosis that increase the risk of coronary heart disease and heart attack and abnormal concentrations occur more frequently in overweight individuals. Weight control is considered as one of the most important tasks aimed at reducing the overall incidence of cardiovascular disease in obese patients.

Gastric bypass reduces heart disease risk

Treatment of obesity should be based on its severity and complaints of the patient. Gastric bypass surgery is a relatively safe procedure, even for patients who have cardiovascular disease. In fact, various studies have shown that gastric bypass significantly reduces the risk of having a heart attack in patients with heart disease during the first year after surgery.

As a person loses weight, blood pressure goes down as well as the risks of cardiovascular complications. The reduction of weight also improves fasting blood glucose concentrations and the action of insulinand reduced serum triglycerides, low density lipoprotein and total cholesterol concentrations.

Gastric bypass improves other obesity related disorders

Not only the surgery for obesity results in sustained weight loss but it also improves or often resolves underlying conditions, including diabetes mellitushypertension, sleep apnea, lower extremity venous stasis, gastroesophageal reflux disease, nephropathy, left ventricular hypertrophy, degenerative joint disease, and nonalcoholic steatohepatitis in the majority of morbidly obese patients.  The net effect is an increase in the quality of life. Through these effects and possibly other independent mechanisms bariatric surgery appears to reduce cardiovascular morbidity and mortality.

Possible complications

Undoubtedly, obesity surgery is a serious surgical intervention which involves certain risks. Postoperative complications occur in approximately 10% of the cases. Most common complications are deep venous thrombosis, anastomotic leaks, internal hernias, gastrointestinal bleeding and others. Some cardiac problems might occur in patients with cardiovascular diseases, because their hearts are required to do more extra work during any surgery or stress.

These problems might occur within 2 days after the surgery, therefore close monitoring should be done for patients who are at a higher risk. However, all postoperative patients need constant monitoring by their doctor to check for other potential problems. However, postoperative complications are usually outweighed by the serious health complications caused by morbid obesity, especially considering the most modern and increasingly safe bariatric surgery.

Nutrition Supplements After Gastric Bypass*

*Please note that each case is individual and the results may vary.

Bariatric surgeries reduce the volume of the stomach and decrease the amount of food a patient may eat which leads to a significant and permanent weight loss. However, reduction of the food intake and modification of the digestive system may cause nutritional deficiencies, therefore patients must take nutrition supplements to guarantee sufficient nutrient intake.

Multivitamins

Multivitamins are usually prescribed after weight loss surgery to avoid the lack of vitamins and minerals. Doctors recommend taking multivitamins which possess a minimum of 100 percent of the daily values of essential vitamins and minerals. Within the first few months after the procedure, liquid or chewable multivitamins are advised as they are digested and absorbed better. They also prevent from heartburn or ulcers formation. When a patient is allowed to eat solid food, then they may switch to non-chewable multivitamins.

Other Dietary Supplements

Although multivitamins fulfil the nutritional needs, extra supplementation may be necessary to avoid deficiencies. Doctors recommend additional supplementation of B complex vitamins, calcium and vitamin D, iron and protein supplements because some multivitamins do not possess a lot of these nutrients or the absorption of these nutrients is decreased due to weight loss surgery. Iron is essential in avoiding anaemia and increasing red blood cell levels. Vitamin B-12 helps to increase metabolismVitamin D and calcium help to maintain solid teeth and the skeleton, among many other functions. These nutritional supplements are usually made as chewable or easy-to-swallow medicaments. Vitamin B-12 is also made as a monthly injection or as a pill that melts under the tongue.

B Complex Vitamins

Vitamin B or vitamin B complex supplements are very important since they possess the riboflavin, niacin, thiamine, pyridoxine, folic acid, pantothenic acid, cobalamin, biotin and vitamin B-12. B vitamins are essential in controlling enzymes that transform food to energy in the body. They also help with cell development and may aid cancer prevention. According to the American Cancer Society, a nutrition poor in folic acid may increase your risk of having particular types of cancer.

Calcium and Vitamin D

After weight loss surgery people must take 1,000 to 1,500 mg of calcium every day. Vitamin D helps the organism absorb calcium more effectively. Calcium is an essential mineral in the body and helps to keep the muscles healthy as well as blood vessels and the central nervous system. Around 99 percent of calcium of the body is stored in the teeth and skeleton.

Iron

Weight loss surgery patients may lack iron. Especially those who have had surgeries with a malabsorptive component. To prevent a potential lack of iron, a multivitamin possessing iron and vitamin C is prescribed. Vitamin C increases iron absorption.

Zinc and Magnesium

Patients who had gastric bypass, gastric band or other weight loss surgery may also suffer from  the lack of both magnesium and zinc, particularly patients who have Biliopancreatic diversion (BPD). Some scientists think that hair loss, which sometimes occurs after weight loss surgery, may be caused by the lack of zinc. Studies do not notify any serious complications caused by the lack of magnesium.

Protein Supplements

Sufficient protein intake after weight loss surgery is essential to maintain the body healthy, because it is used in the diverse processes in the body and is important in the healing process. High level protein supplements are perfect and an easy way to make sure that patients are getting enough of protein which is  approximately 60 to 80 grams every day. A variety of high level protein supplements are available in powder consistency which can be melted in water. It is helpful within the first few weeks after the procedure when patients are on a liquid nutrition.

In general, restrictive surgeries carry the lowest risk of nutritional deficiencies after

surgery. Bariatric malabsorptive surgeries lead to nutritional deficiencies more often than the non-malabsorptive ones and individuals who have those surgeries must take supplements.

Gastric Bypass Increases Risk Of Alcohol Abuse

Gastric bypass surgery became a common and effective way of weight loss for morbidly obese individuals to treat obesity and associated complications. The surgery limits the body’s ability to absorb calories by decreasing the stomach size and attaching it to the lower part of the intestine, making people feel full faster.

Lifestyle changes after gastric bypass

Gastric bypass is a life changing surgery. Not only a person looks and feels different after losing all this extra weight but one usually changes his or her habits as well. After gastric bypass a person’s eating habits change completely. Firstly, a person cannot eat as much and most gastric bypass patients barely tolerate fast food. Besides, people tend to become more sociable, outgoing and physically active. However, despite the significant benefits of gastric bypass surgery, the risk of developing behavioral diseases such as alcoholism increases. Why?

Trading food addiction to alcohol

Alcohol goes straight into the intestine where it is absorbed rapidly. Unfortunately, some obese people may suffer from addiction transfer, potentially trading a food addiction to alcohol or a drugs abuse problem. In addition, there is evidence that the highest rate of postoperative alcoholism is seen in patients who displayed binge-eating behavior before surgery.

Changes in alcohol metabolism

Several published medical studies indicate that alcohol metabolism changes after bariatric surgery. Patients respond differently, both physically and psychologically. Therefore, they are more sensitive to the effects of low doses of alcohol. These patients experience different symptoms and they might not recognize that they have consumed too much alcohol. Gastric bypass patients’ blood alcohol levels rise higher and stay up for longer than if these patients had consumed the same amount of alcohol before the surgery. It is believed that because of these reasons, alcohol consumption can lead to alcohol abuse and dependence.

Alcohol may lead to weight regain

Alcohol consumption after gastric bypass surgery may lead to weight regain. Studies have suggested that alcohol consumption is associated with greater caloric intake, even when adjusted for the calories in the alcoholic drink. Alcohol increases caloric intake and increases lipid consumption. However, calories consumed in liquids do not bring the same feeling of fullness as the calories consumed from solid foods. Alcohol is known to relax the lower gastroesophageal sphincter and increase gastric emptying, which allows a person to eat much more than normal amounts of food. For all of these reasons, alcohol consumption can potentially lead to weight gain and must be advised and treated with caution by bariatric patients.

Alcohol consumption may double risk

Gastric bypass surgery reduces the risk of mortality from obesity, but alcohol use during the postoperative period can impact the patients’ health. Patients that are undergoing gastric bypass surgery or other bariatric surgery must be warned that they could experience a major difference in their capacity to handle alcohol after their surgery. Alcohol abuse may affect the vitamin and mineral status and liver function which are already potential problems for the surgery patients. Also, alcohol abuse can lead to weight gain and increases the risk of automobile accidents, alcohol poisoning and encephalopathy. Patients should be screened for alcohol problems before and after the surgery and told about the risks in order to stay healthy.