Weight Loss Surgery and Bone Loss

Gretchen Becker Health Guide
  • If you’re obese and can’t seem to lose weight any other way, weight-loss surgery can be the boost you need to get your weight under control. It not only helps you lose weight but usually improves control of your blood glucose levels. Here is a sharepost by a Health Central blogger who had success with the surgery.


    Unfortunately, such surgery is not without risks and side effects. Any surgery, even minor surgery, can cause harm if something goes wrong, for example, an infection of the wound. After any surgery that restricts the size of your stomach, your ability to eat large meals is eliminated, and you can have a bad reaction if you eat too much or if you eat certain foods such as sugars, which can cause dumping syndrome.

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    But surgery such as the Roux-en-Y surgery, in which your intestine is rerouted so that the food bypasses the first portion of the small intestine, called the duodenum, also results in some nutritional deficiencies, as some nutrients are usually absorbed in the portion that is bypassed. For this reason, if you’ve had that operation, you will probably take nutritional supplements for the rest of your life. And the initial success from the surgery may be followed by some weight regain, as chronicled here by the same Health Central blogger that had the initial success.


    Also, because this procedure is relatively new, no one knows the long-term effects of altering your digestive system in this way.


    Now a study in rats has shown that the rats with the Roux-en-Y gastric bypass but not those with another procedure, the Vertical Sleeve Gastrectomy, which restricts the size of the stomach greatly, had a loss in bone mass. Rats in both groups lost weight and had improvements in their glucose tolerance. But the Roux-en-Y rats had less absorption of fats from their intestine and lower vitamin D and calcium levels as well as decreased bone mass.


    Because of the vitamin D and calcium absorption problems, patients who have had bariatric surgery are told to supplement with these nutrients. However, in the rats, supplementation with vitamin D and calcium did not bring bone mass completely back back to normal.


    It is well known that weight-loss surgery can cause changes in vitamin D and calcium levels, but the researchers could not explain why this bone mass decrease in rats occurred despite supplementation with these nutrients.


    Of course, bone mass is proportional to weight, and a study in women showed more bone loss with women who had the Roux-en-Y procedure, but they also lost more weight. Some people are warning of the dangers of weight-loss surgery for this reason, especially in younger patients.


    Does this mean no one should ever have weight-loss surgery? No. When you’ve tried everything else and nothing has worked, it may be worth a try. Obesity itself is associated with side effects, including type 2 diabetes.


    However, it does mean that this surgery should not be taken lightly. Because the surgery does almost always cause improvements in glucose control, some people are suggesting it for normal-weight people with type 2 diabetes. But is it worth all the risks of bariatric surgery to control your diabetes when other options are available?


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    One alternative is the Endobarrier, which is a sleeve that is inserted into the intestine to effectively block the duodenum, the part of the intestine that is bypassed in the Roux-en-Y procedure. Major bariatric surgery is mostly irreversible, although some less-restrictive bariatric procedures can be reversed. The Endobarrier can be removed and in fact is recommended for use for only about 12 months.


    The Endobarrier is being used in the United Kingdom but has not yet been approved in the United States. However, clinical trials here have begun.


    The Endobarrier is new, and perhaps serious side effects will emerge as more people use the device. But it seems to me that it would be a better first step to controlling your diabetes and losing weight than major surgery that is not reversible and that may have lifelong deleterious effects on your metabolism.





Published On: June 19, 2013