Metabolic Surgery Tips

Bariatric surgery (weight loss surgery) includes a variety of procedures performed on people who have obesity. Metabolic surgery is defined as “a set of gastrointestinal operations performed with the intent to treat diabetes (diabetes surgery) and metabolic dysfunctions (which includes obesity). Over the past 5 years, the term “metabolic surgery” has become increasingly popular. In 2002, it was suggested that gastrointestinal surgery could be used with the primary intent to treat type 2 diabetes. The idea derived from the factor that the gastrointestinal tract is a major player in the regulation of glucose homeostasis.

In patients with a BMI above 35, surgical treatment of diabetes is now recommended by virtually all professional organizations.

Weight loss is achieved by:

1. Reducing the size of the stomach with a gastric band or through the removal of a portion of the stomach
2. By resecting and rerouting the small intestine to a small stomach pouch.

Statistics

Long-term studies show that the procedures cause significant long-term loss of weight, recovery from diabetes, improvement in cardiovascular risk factors, and a mortality reduction from 40% to 23%.

Indications for Bariatric Surgery

1. Excess body weight affecting the quality of life and restricting routine activities
2. Patients with a BMI of 40 kg/m2 or greater who instituted but failed an adequate exercise and diet program (with or without adjunctive drug therapy
3. Patients who present with obesity-related comorbid conditions, such as hypertension, impaired glucose tolerance, diabetes mellitus, hyperlipidemia, and obstructive sleep apnea

Types of Bariatric Surgery

1. Vertical sleeve surgery
2. Gastric bypass surgery 
3. Intragastric balloon surgery
4. Duodenal switch surgery
5. Lap band surgery

Eating Schedule After Bariatric Surgery

Immediately after bariatric surgery, the patient is restricted to a clear liquid diet until the gastrointestinal tract recovers from the surgery. This is followed by a blended diet for at least 2 weeks, consisting of a high protein diet and dairy products. Foods high in carbohydrates are usually avoided when possible during the initial weight-loss period. Many patients need to take a daily multivitamin pill to compensate for reduced absorption of essential nutrients. 

Effectiveness of Surgery

• Weight loss
• Reduced mortality and morbidity
• Psychiatric/psychological health can improve after bariatric surgery

Adverse Effects of Surgery

1. Metabolic bone disease manifesting as osteopenia and secondary hyperparathyroidism
2. Rapid weight loss after obesity surgery contributing to the development of gallstones
3. Hyperoxaluria that can potentially lead to oxalate nephropathy and irreversible renal failure
4. Rhabdomyolysis leading to acute kidney injury and impaired renal handling of acid and base balance has been reported after bypass surgery
5. Nutritional derangements due to deficiencies of micronutrients

Complications of Bariatric Surgery

• Anemia
• Osteoporosis and bone degeneration
• Malnutrition
• Dumping syndrome
• Erosion
• Spleen injury
• Suture-line disruption
• Long-term nausea and inability to tolerate food
• Hernia
• Migration of the band
• Narrowing of the stomach outlet (stenosis)
• Leakage
• Ulcers
• Constipation
• Nutritional deficiencies
• Weight Regain

A lot of diets claim to help ‘boost’ metabolism – but can you really do anything to help your body burn calories faster?

Let us understand a little about how your metabolism works. The metabolic process involves a complex network of hormones and enzymes that not only convert food into fuel, but also affect how efficiently you burn that fuel. How fast you burn calories is influenced by your age ; your gender  and proportion of lean body mass . So some people have high metabolic rate as compared to others.

Even though you are not born with “skinny genes” , you can still speed up your metabolism i.e.  increase your body’s ability to burn calories faster.

Exercise.  Working out builds muscle. Muscle speeds metabolism. As the body works more efficiently, it processes food faster.

Besides exercise there are other things which boost up your metabolim.

1.  Spices: Research has found  red peppers  can rev up your metabolism, while also helping you feel full.  Hot sauce, hot peppers, ginger, cloves, cayenne, coriander, bay leaves, and dry mustard share this capacity to boost metabolism.

2. Caffeinate: Coffee, tea, or other caffeinated (but low or no-calorie) beverages may also help burn calories faster. In fact, caffeine may boost your metabolic rate for up to three hours after consumption. But don’t overdo caffeine if it gives you the jitters or keeps you up at night. For most people, 3-4 cups per day is tolerable.

3. Stay Hydrated: Even mild dehydration has been found to decrease your metabolic rate by 2%, so staying well hydrated is an easy way to help boost overall metabolic rate. People who drink either eight or twelve  glasses of water a day have higher metabolic rates than those who have four.

4. Eat More Often:   Small, frequent meals help keep your metabolism  high , and that means you’ll burn more calories overall. When you put too many hours between meals, your metabolism actually slows down to compensate. If you then eat a huge meal — at the same time your metabolism is functioning as if you’re starving — your body wants to hold on to every calorie. While this won’t make much difference on an occasional basis, it can become more difficult to lose weight or maintain weight a healthy weight if you frequently skip meals.

1. Take proper sleep of eight hours.
2. Drink plenty of water, if you don't like plain water add cucumber, lemon, pineapple, mint etc to add flavor.
3. Add chilli peppers to your regular diet.
4. Dont skip your regular meals.
5. Take low carbs.

The “Roux en Y Gastric Bypass” surgery was first performed by Professor Mason in 1966. Being done in the conventional way (i.e by open surgery) earlier and later laparoscopically, the Gastric Bypass has stood the test of time over the last 52 years.

Over 50 years the Gastric bypass surgery is being performed across the globe. It has given excellent results in terms of significant and long-standing weight loss in the morbidly obese, as well as remission of Type 2 diabetes in properly selected patients. Selection of the patient to undergo this procedure is paramount. 50 years of successful results are enough to term this procedure as the GOLD Standard.

Obesity and Diabetes have been a menace over the last 2 decades world over. In India obesity is growing in such a rampant way that we can equate it to an epidemic.

As we all know, India is considered to be the Diabetic Capital of the world. Type 2 diabetes contributes to the major chunk of diabetes affected population. We Indians get affected by diabetes at very early ages and hence complications are seen at very early ages among us. Strikingly important to notice is that Diabetes is seen not only in the obese category of people but also in the normal weight people.

Diabetes is feared of only because of the complications it is capable of causing affecting the vital organs like the brain, heart, eyes, kidneys.

Intermittent or elevated surges in the blood sugars levels during the course of the day are responsible for causing microangiopathies ( damage to the small vessels supplying blood to the vital organs).

We have seen that diabetes is accompanied by high blood pressure and dyslipidemia in most of the cases. So, when a person has diabetes, high blood pressure and dyslipidemia, we label them as having the metabolic syndrome.

Oral hypoglycemic agents (OHA) and insulin form the mainstay of treatment in getting sugars under control. But these are not able to avoid these surges in high sugar levels. This does not mean that OHA’s and Insulin are not the right way to treat diabetes- they indeed are.

We are going a step higher, in an attempt to get control of diabetes without OHA and insulin. Not only this, we are trying to tackle not just diabetes, but the metabolic syndrome on the whole i.e one procedure that will take care of diabetes, dyslipidemia and hypertension. This procedure is popularly known and referred to as the “Gastric Bypass” or the “Roux en Y Gastric Bypass”. Thus, In short, the gastric bypass surgery offers ICE BURG treatment.

Now, the first question is that “Is this possible”. The answer is YES. The second question is that is this procedure applicable for all diabetics. The answer is NO. Only Type 2 diabetics are the beneficiaries of this procedure where insulin resistance has a major role to play. (This procedure does not benefit Type 1 diabetics) Reasons for this will be explained later. The third and important question is that, “Is the Gastric bypass going to give remission of diabetes in all type 2 diabetics?” The answer is NO.

There is strict selection criterion or eligibility criteria to select a patient for The Roux en Y Gastric Bypass surgery. Best results of the Gastric Bypass surgery are seen when it is confirmed that the person is suffering from Type 2 diabetes, duration of diabetes is less than 5 years, the pancreatic reserve is good and showing good levels of C -peptide in the blood, the person has a family history of diabetes, Insulin was not required to control sugar levels within the first 5 years of onset of diabetes and person should not be underweight( BMI > 27.5 preferred).

Losing weight is not easy and even if we lose weight, weight regain is very common. Most of us would have already experienced it. When we are tackling just the weight issue, we are talking into consideration only the morbidly obese people who have a BMI > 37.5. In the morbidly obese, at first, it is very difficult to lose significant weight by the normal method of diet and exercise. Even if weight loss does occur, weight regains or bouncing back is sure.

Here we bring in the trump card – The “Roux en Y Gastric Bypass” that helps the :

1. “Morbidly Obese” (BMI >37.5) to lose significant weight and reach their ideal weight.
2. “Obese” (BMI >32.5) who also have comorbidities (like diabetes, hypertension, dyslipidemia, sleep apnea, obesity-induced infertility) not only to lose significant weight and reach their ideal weight but also to get control of the associated comorbidities.
3. “Type 2 Diabetics” (BMI > 27.5) to get Remission from type 2 Diabetes.
4. “Metabolic Syndrome” (BMI > 27.5) to get remission from type 2 diabetes, dyslipidemia and Most cases hypertension.

Type 2 diabetics can be offered this procedure even if they are not morbidly obese, is what I would like to bring it to notice.

Exposure to Type 2 diabetes for long years can lead to potential complications like coronary heart disease, chronic kidney failure, brain stroke, gangrene of the lower limbs.

In some, in spite of talking OHA’s, Insulin, sugars are not under control. In these cases, the gastric bypass can be offered to those who fulfil the eligibility criteria.

Remission of diabetes after the gastric bypass procedure is very quick, ranging from a week to a month in most of the cases. However, in some, The sugar levels come to normal the very next day after the surgery in some without the OHA and /or insulin.

Gastric bypass is done through laparoscopy i.e through tiny holes over the tummy, requiring 3 days hospital stay. Supplements need to be taken following the procedure on a daily basis. Following the procedure, intake is reduced to a great extent which increases over few months as the gastric pouch stretches.

In case you have a concern or query you can always consult an expert & get answers to your questions!

To slow down your metabolic rate and put on weight quickly, you can make sure that breakfast, lunch and dinner are huge and well spaced out.

Enhancing Your Metabolism!