Fully Informed Consent For Weight Loss Surgery

“If I would have known the consequences of this, I wouldn’t have done it,” is a common statement from patients who have had irreversible surgical procedures for weight loss.

Surgical weight loss involves restriction, malabsorption, or a combination of these mechanisms. Restrictive procedures reduce stomach size and include laparoscopic adjustable gastric banding (LAGB) and vertical sleeve gastrectomy (irreversibly removes most of the stomach).

Patients who have LAGB may have initial success in weight reduction, but most gain the weight back along with depression and guilt of failure. Unfortunately, patients aren’t taught how to consume a nutritious diet that promotes fat burning, rather than fat storage. Complications develop in up to 25% of LAGB, including band slippage and pouch dilation; band erosion; esophageal dilation and inflammation; device-related complications; and gastric necrosis.

Malabsorptive procedures decrease the degree of small intestinal absorption of nutrients by bypassing a large portion of the small intestine called the duodenum. This also bypasses the area where the gallbladder and pancreas enter the small intestine to deliver digestive enzymes (to break down foods for nutrient absorption) and bile (needed for fat absorption).

Although malabsorption can result in short-term weight loss, depression, anxiety, insomnia and decline in physical health resulting from nutrient deficiencies quickly lead to overeating “comfort” foods and weight gain. Lets examine why.

Since the parietal cells of the stomach create hydrochloric acid (HCL), removal of stomach tissue results in loss of production of this imperative digestive component. HCL’s acidity is our body’s first line of defense against foodborne illness and infectious disease. Lower acidity allows bacterial growth leading to gastroporesis (lack of stomach emptying) and small intestinal bowel overgrowth (SIBO), a known cause of irritable bowel syndrome.

HCL deficiency leads to protein malnourishment. Proteins are long chains of amino acids and are used to make neurotransmitters, enzymes, and tissues of the body. In addition to unfolding proteins, HCL stimulates secretion and activation of pancreatic enzymes that cleave off amino acids so they can be absorbed. Consequences of amino acid deficiency include depression, ascites (fluid in abdominal cavity), neural and brain disorders.

HCl also prepares other food particles for absorption. For example, the acidity of HCl is imperative for iron absorption, which occurs predominately in the duodenum. Iron deficient anemia and fatigue is common after bypass surgery.

HCL stimulates the release of bile acids, which enable the absorption of fats. Fat-soluble vitamin A, D, E and K deficiencies occur after gastric bypass surgery. These vitamins are imperative for our eyesight, bone density, immune function, detoxification, nerve function, inflammatory regulation and blood clotting.

Intrinsic factor, needed for absorption of vitamin B12, is also made by stomach parietal cells. Macrocytic anemia, fatigue and permanent nerve and brain damage are among the consequences of B12 deficiency.

Nutrient deficiencies are just one consequence of the surgical approach to weight loss. Normal body weight can be accomplished with changes in diet and lifestyle and it’s NOT necessary to starve oneself, use dangerous hormones or purchase expensive diet foods. Check out our website for more information about our “get healthy and achieve normal body weight program,” A Way Of Life.