Monthly Archives: April 2011

Supplementation to Prevent Addiction after Gastric Bypass Surgery

I was inspired to write today’s blog, as I was corresponding back and forth via email with someone explaining to them how I thought taking my supplement regime could potentially have prevented problems with anxiety, nutrient defiency, and addiction after Roux-en-Y Gastric Bypass Surgery.

What I’m afraid may be happening in more cases than they know is that sometime around 18-24 months, the body’s stores of reserve nutrients have been depleted and the body begins to experience malnutrition for one or more nutrients due to the malabsorption factor. I think this, in turn, may cause neurological problems and health problems that result in behavioral changes that can include anxiety, rapid heartbeat, aggression, insomnia, confusion, etc. Whether this would be caused from deficiencies in calcium, Vitamin D, magnesium, niacin, B-12, iron, whatever, or a combination, who knows?

This surmising is not unlike iron deficiency causing Pica which causes people to crave eating strange things such as ice or clay, or pellagra (the B3 deficiency) which can cause mental confusion, insomnia, and aggression, or beriberi (now they have a version called bariatric beriberi). In trying to self-medicate those symptoms, and with the double-whammy of the the way Roux-en-Y affects the way alcohol is metabolized (you are intoxicated faster and take longer to get sober), I think alcohol could be even more addictive than it would have otherwise been with a pre-surgery stomach. I’ve been told by others as well, in their words, “It feels different – I feel different”.

That’s why I would have taken the supplements from Day 1, if I had known then what I know now – To have prevented that early onset of nutrient deficiency. It is the potential for neurological problems associated with nutrient deficiency that I believe puts people at risk, and also impairs their judgment, combined with the increased effect alcohol has on WLS patients, that I believe is the root cause in the huge increase in the number of people developing addiction after WLS.

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Magnesium Deficiency Causes Personality Change and WLS Patients are at Risk

I just read the article by the WLS advocate, Kaye Bailey, titled “Magnesium Deficiency Causes Personality Change and WLS Patients are at Risk” and I decided to make that the topic of this blog.

In that article she described a distinct personality change in herself – feeling that she’d lost her mind. Here is an excerpt:
“Have you ever felt like you were completely losing your mind? Like the world was swallowing you up and little things were out of your control and unmanageable? Like you were confused, tired, out of sorts and simply wanted to collapse?”

She later quotes from Dr. Bernard Jensen’s Guide to Body Chemistry & Nutrition”:

“I want to point out here that the classical deficiency symptoms for magnesium include neuromuscular signs, such as tremors, weakness, muscle spasms and irregular heartbeat; gastrointestinal signs such as nausea and vomiting; and personality changes that display confusion, apprehensiveness and depression. In the “old days” people with magnesium deficiency were often (mistakenly) taken to mental institutions because they acted so radically different that they literally seemed to be mentally ill.”

I had Roux-en-Y gastric bypass surgery in March of 2000. Approximately 18-24 months after surgery – after the “honeymoon period”, symptoms such as anxiety – a feeling like something wasn’t right but I didn’t know what it was overcame me.   As time went by these symptoms got worse, and I had no idea why. I began to start snacking – “grazing” if you will, to take this “edge” off.   I call it, feeling “like a shark in shallow waters” – kind of that feeling when you stare at the pantry or fridge – know you want or need something, but don’t know what it is.

More time went by with no relief. Symptoms had progressed to these feelings of panic where my heart would just begin to race – frequently on my drive home from work – what I would come to call “panic attacks”. For no apparent reason at all (or so it seemed) my heart would just start racing. It also became difficult for me to concentrate and focus. I was no longer able to follow an hour long TV program, read a novel, then could no longer follow a half-hour program, had difficulty balancing my checkbook (and I had it set up in Excel – which I had designed and programmed myself before). My favorite was (and remains) the Daily Show with Jon Stewart, and I knew something was really wrong when I couldn’t follow an entire show.   By this time, I also had developed swelling on my calves and small bruises all over that were unexplained.

Years went by with little relief and another trip to the ER, this time with a resting heartrate of 165 bpm.  By simple serendipity I followed up with a family doctor who also happened to have had Roux-en-Y gastric bypass surgery. It took him all of sixty seconds of hearing my story and looking at my medical history (he actually did read it) – and told me that I was likely deficient in magnesium (called hypomagnesaemia).   Added to the research I had already begun to do, it made a lot of sense.

We went over the supplements I was already taking – added some that he thought I should add including the magnesium. I then began researching and reading about magnesium and was astonished I hadn’t heard of this before.  I started taking magnesium oxide but quickly learned that it was only about 4% absorbable in a normal stomach. I’ve since switched to magnesium taurate and I also squirt magnesium oil on my skin for transdermal absorption. Some of the other forms of magnesium can give you a little condition well – let’s just say you spend a lot of time in the bathroom.

I haven’t had a single “panic attack” since!

If you are interested in additional information regarding magnesium, there is a great book called “The Magnesium Miracle” by Dr. Carolyn Dean. It explains that a serum blood test for magnesium really won’t tell you very much about your overall magnesium levels, as only 1% of the body’s magnesium is in the blood and 40% is in the tissues. The EXAtest is one of the magnesium testing methods the book discusses and it is a test that gives information about the levels of magnesium in the heart and muscle cells. The book also goes into great detail explaining the effect magnesium deficiency has on cardiovascular health, diabetes and obesity, PCOS, Osteoporosis and kidney stones as well as cholesterol and high blood pressure. There are many other great sources of information out there as well, this just happens to be one of the books I’ve read.

I’ve since discovered, this hasn’t just happened to me. On the gastric bypass surgery and obesity online forums – there were numerous postings of people who had discovered they were magnesium deficient – and chronicled how they were able manage it and whether magnesium supplementation improved their symptoms.

I’ve included the links to the sources I’ve used :

http://dearpharmacist.com/?p=1598

http://ezinearticles.com/?Magnesium-Deficiency-Causes-Personality-Change-and-WLS-Patients-are-at-Risk&id=42918

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Vitamin D Supplements weren’t Sufficient for Gastric Bypass Patients

Another new Research study from the University of Maine by graduate student Joanna Fichthorn Rosebush titled “THE EFFICACY OF THREE DIFFERENT VITAMIN D SUPPLEMENTATION PROTOCOLS AFTER THE ROUX-EN-Y GASTRIC BYPASS PROCEDURE” concluded that while there didn’t appear to be a difference in the efficacy between those receiving supplementation with vitamin D2 versus vitamin D3, they all were less effective than expected.

Twelve-months after surgery, 72% of subjects taking 50,000 IU D2 weekly had optimal vitamin D status. Fifty percent of subjects taking 2800 IU D3 daily and 50% of the subjects taking 1200 IU D3 daily had optimal vitamin D levels. That means 28% – 50% were not!

In another study published in the February 2008 issue of Obesity Surgery: “VITAMIN D AND THE BARIATRIC SURGICAL PATIENT: A REVIEW” this was the conclusion: Both secondary hyperparathyroidism and bone loss were common, particularly when the obesity surgery included a malabsorptive component. Standard postsurgical supplementation with vitamin D and calcium have not been adequate to suppress secondary hyperparathyroidism or to restore 25-hydroxy vitamin D status.

The reason this is so startling is that these patients were taking high doses of the vitamin and on a frequent and monitored basis. As I’ve posted before, Vitamin D is not a vitamin most doctors tell their patients to supplement with. I received some blowback from my prior “Flintstones” postings from those who were just fine. But based on this study, anywhere from 28%-50% can still be deficient even with supplementation. What does that say for all of those patients who aren’t supplementing with Vitamin D – and studies show as many as 30% don’t even take a multi-vitamin – I bet it’s even higher for Vitamin D because they just don’t know?

I have been taking 5,000 – 6,000 IU of vitamin D3 per day and my levels were only 46. I would have thought they would be higher considering the supplements I was taking.

What does Vitamin D do and what are the symptoms of deficiency? I think that is the biggest problem – that most doctors aren’t familiar enough with symptoms of nutrient deficiencies and do not associate behavioral changes with nutritional deficiencies – in addition to which there may not be simple laboratory testing methods available.

Deficiency in vitamin D can cause cognitive impairment, impairs the body’s ability to appropriately utilize the calcium that many patients do take compliantly, impairs the immune response systom, is associated with increased cardiovascular problems, high blood pressure and increased risk of cancer. How can it affect so many areas? Because other nutrients (vitamins and minerals) are dependent on it to do their job – it’s the limiting factor. So when looking at symptoms of vitamin D deficiency you also need to look at symptoms of calcium deficiency, parathyroid impairment, pancreatic impairment, etc.

Vitamin D is one of the fat-soluble vitamins and you can obtain it from only a handful of natural dietary sources (fatty fishes), fortified dietary sources (milk, yogurt, cereals) and your body can generate it in the presence of sunshine. Supplements use either vitamin D2 (ergocalciferol) or D3 (cholecalciferol). Most medical professionals are recommending the D3 form, but this study seemed to indicate not much difference between the two. Most fortified foods use the D2 form as it is the cheaper form.

When they test your blood for vitamin D, they test mean serum 25(OH)D concentrations. There was been much debate in the medical community of late as to what is an optimum level for health, versus the minimum to keep adverse health effects away. Normal values according to the lab are considered between 33-49 ng/ml and optimum levels are 50-65 ng/ml. I am still only in the normal range. I would rather be in the optimum.

Here is an exerpt from the following website: “Obese individuals who have undergone gastric bypass surgery may become vitamin D deficient over time without a sufficient intake of this nutrient from food or supplements, since part of the upper small intestine where vitamin D is absorbed is bypassed and vitamin D mobilized into the serum from fat stores may not compensate over time”.

http://www.endotext.org/parathyroid/parathyroid3/parathyroidframe3.htm

You can find the studies I referenced here:

http://www.umaine.edu/graduate/research/efficacy-three-different
http://www.ncbi.nlm.nih.gov/pubmed/19017827?dopt=Abstract
http://www.ncbi.nlm.nih.gov/pubmed/18176832?dopt=Abstract

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Rate of Suicide Increases after Gastric Bypass Surgery

The Archives of Surgery has published in the 2007 October issue the following article: “Death Rates and Causes of Death After Bariatric Surgery for Pennsylvania Residents, 1995 to 2004″. They examined the results of 16,683 patients and found that there were 16 confirmed suicides (4%) and 14 drug overdoses (3%) that were not attributed to suicide. To put that in perspective, the The US Vital Statistics rates of death due to suicide
for white women are approximately 7 per 100,000 and for white men are 25 per 100,000 among the population for a comparable age range. These are alarming numbers. Here is a direct comment from their paper:

“It is very likely that suicide deaths were also underestimated because some of the deaths were listed as drug overdoses rather than suicide on the death certificate. The large number of deaths due to suicide and drug overdose, in excess of what we expected, is also a cause for concern.”

In another study published in the New England Journal of Medicine, “Long-Term Mortality after Gastric Bypass Surgery” they followed the outcomes of 9,949 patients and even though mortality from health related problems had declined. This study showed 21 documented suicides (7.29%), 25 other non-disease caused and 15 poisoning of undetermined intent. Even though the authors of this study did recognize the extraordinary increase in suicide, the conclusion drawn was that it was psychological, and related to unresolved psychological trauma.

Two studies strongly indicate that after gastric bypass surgery, the rate of suicide is significantly higher than in the control group. And as I’ve posted earlier there are studies that show this surgery is also capable of causing malnutrition from the malabsorption. I wish they had indicated in the suicide group what type of surgery that had, whether it was the Lap-Band or a bypass type of surgery. I think once they start breaking this out, it will become obvious that it is not the psychological issue they claim.

There appears to be the assumption that obese and morbidly obese and therefore people who have chosen to have WLS have higher instances of mental illnesses than the general population.   Is there the data to actually support that?

If you want to read the study yourself you can at:
http://www.nejm.org/doi/pdf/10.1056/NEJMoa066603
http://archsurg.ama-assn.org/cgi/reprint/142/10/923

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I rewrote some of this blog based on feedback from this forum . I will always welcome well intentioned criticism and critique and am open to learning as much as I can on a subject where there is so much yet to learn. After re-reading the blog entry, I did agree that parts were poorly written and did not reflect what I was trying to convey. It did appear that I was saying gastric bypass surgery caused suicide. That was and is not my contention. I recognize that human behavior is incredibly complex. When there are two separte studies both showing a marked increase in suicide, I believe it would be irresponsible of the medical community to simply ignore it. I do believe this calls for further investigation to see if the malabsortion component could have played a part, and if so, what, or aggravated a prior condition. Or perhaps it calls for the current recommended post-operative care modality to be re-examined? Whatever the findings call for.

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A Flintstone a day Ain’t Enought

The American Journal of Clinical Nutrition has published the article “Nutritional Deficiencies after Roux-en-Y Gastric Bypass for Morbid Obesity Often Cannot be Prevented by Standard Multivitamin Supplementation”. One of the startling finds in their study to me was that only 33% of the participants were compliant in taking their vitamins at all. Their study found that at three months 34% of the study participants needed at least one supplement, by 6 months the number had increased to 59% and by month 24 the number was up to 98%. The conclusions of the study were
(1) A single multivitamin is insufficient post-Roux-en-Y gastric bypass to prevent deficiencies. In fact 60% were deficient within six months and virtually all participants were deficient within 24 months.
(2) The vitamin D and calcium deficiency prevalence corresponds with the length of the Roux-en-Y limb.
(3) Proper and adequate post-operative supplementation may become burdensome and expensive and challenge patient compliance.

I have to say that I was thrilled to see that there was a study done on this subject. I still get emails that doctors are telling their patients a Flintstone a day is enough. This study shows that you absolutely need to commit to much more than that. I wish they had gone into what those deficiencies are and what the signs and symptoms are, but I guess that can be for a later study. I don’t think that many doctors and patients know what the symptoms of deficiencies of iron, calcium, magnesium, thiamine, etc., are and how they can present, such as ice craving, agitation, heart racing or “panic attack”…. I friend of mind developed peripheral neuropathy. He also broke his leg one Christmas. After six weeks in a cast, expecting to get his cast off, he went back to the doctor, they X-rayed his leg and there had been absolutely no recalcification of the break. And he had been taking his Calcium Citrate as directed.   They ended up having to double the dose and healing time .

If anyone would like to read this study for themselves it is located at: http://www.ajcn.org/content/87/5/1128.full.pdf

I just got the blood work back from my doctor and my cholesterol was 143, HDL was 58, my LDL was 70 and my Triglycerides were 76. Excellent – so far so good!   Like I said earlier.    D was only 46 and expected it would be higher.

I was astonished to see in this study that only 33% take their vitamins!

My daily regimen:

High Potency Multi Vitamin – 6 x per day (2 softgels are a “serving”)
Magnesium Taurate – 125 mg 5 x per day (plus I spray magnesium oil on my skin for transdermal absorption) – I have never had a “so called panic attack since I started taking magnesium”
Omega-3 Fish Oil – 3 TBS per day (Carlson) – Barlean’s is supposed to awesome though (comes in Pina Colada)
Vitamin D3 – 2 5,000 IU per day
Calcium Citrate – 2,000 mg (4 TBS Nature’s Blend Blueberry)
Vitamin A – 10,000 IU 2 x per day
Vitamin E – 400 IU 1 x per day
Multi-Mineral Capsule – 1x per day
B12 – injection 1cc per month
Niacin (non-Flush) – 500 mg 2x per day  (may stop taking with cholesterol numbers)
Tyrosine – 500 mg – 3 x in the morning
Taurine – 1500 mg – evening (as needed)
1 protein shake/bar per day

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First Blog – It’s Not Addiction Transfer

I am writing my first ever blog to try and get the message out to as many gastric bypass patients and soon to be patients – Be Careful.   The surgeons aren’t giving you all the information and most of the websites are populated with people who (like me) are in their “honeymoon period” and so excited to share their happiness and success with others.

The dirty little secret they aren’t telling you is that an alarming number of people who have the Roux-ex-Y procedure (a bariatric procedure that bypasses a significant portion of the small intestine) are succumbing to alcoholism, depression, peripheral neurapathy, addiction, suicide and other “unexplained” deaths.   Once you start googling it and know what you are looking for you may be astonished.

For a variety of reasons and lots of study, I believe it has something to do with the bypassing of the intestine.  So many stories were similar.   The “troubles” didn’t start right away, but well after their followup with their surgeon (ie., after the first year).   Made me think, it was related to exhausting nutrient reserves.   A friend had the lap-band and didn’t seem to be experiencing any of these problems, while all of my friends with Roux-en-Y were experiencing some type of problem.

I think this problem is vastly under-reported as well.   The ones that actually report experiencing “alcoholism” or “addiction” are the extreme, but I think there are far more struggling silently in between.   Not talking to their doctor, not understanding what is going on with them – that something is wrong, why they don’t feel right?

Many physicians self-admit their lack of nutritional knowledge – that they received very little education in med-school and they wouldn’t necessarily recognize an overweight “malnourished” patient if one presented.

If you think any of this applies to you, please contact me.  I’d love to hear from you.

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