Monthly Archives: October 2011

New Study – Gastric Bypass Increases Risk for New-Onset Alcohol Abuse (Now You Tell Us?)

I recently came across this article.   It’s from a presentation at the 2011 Obesity Conference in Orlando, Florida about the phenomena of new-onset alcohol abuse after gastric bypass surgery

I actually did appreciate this article, because this was one of the few articles that did not just summarily dismiss this as a psychological transfer issue.   The fact that new-onset alcohol abuse is in fact an extreme behavioral change seems to have finally caught the attention of some scientists.  They have begun to investigate this and ask some important questions – such as when the onset began? how quickly the abuse progresses? whether or not there was a history of alcohol abuse prior to surgery?  the average age of the person when the abuse sets it, etc.,

Some of the questions I would still would like to know are, did all of these people have the Roux-en-Y, or do these findings hold true for Duodenal Switch and Sleeve Gastrectomy?

Here is the text from the article from Medscape by Steven Fox:

Gastric Bypass Increases Risk for New-Onset Alcohol Abuse

Steven Fox

The poster was presented at Obesity 2011: The Obesity Society’s 29th Annual Scientific Meeting.

“Our data underscore the need for asking patients during their preop evaluation about their use of alcohol, and again when following up after surgery,” presenter Stephanie Sogg, PhD, told Medscape Medical News. Dr. Sogg is a clinical staff psychologist at the Massachusetts General Hospital Weight Center in Boston.

Dr. Sogg said that several years ago she began hearing from patients that not only was alcohol having a far greater effect on them after surgery than before, but also that some were developing full-blown alcoholism after surgery — even if they had never had a previous problem with drinking.

And what was most intriguing, Dr. Sogg said, was that many of the people who were becoming alcoholics were middle-aged. That is long after most people begin to have alcohol-related problems. Data from the National Institute on Alcohol Abuse and Alcoholism indicate that the mean age of onset of alcohol abuse is 22 years.

“Although there’s not much in the literature on the subject of alcohol abuse following Roux-en-Y surgery, there’s quite a lot of discussion among weight loss specialists — anecdotal evidence — that this is a problem,” she said.

To find out more about a possible link, Dr. Sogg and her colleagues conducted telephone interviews with 340 patients who had undergone RYGB surgery at Massachusetts General Hospital in Boston. All procedures had been carried out at least 18 months before the survey.

About three quarters of the patients were female, and 91% were white. Mean age at the time of surgery was 46 years, and the mean time since surgery was 57 months.

Surveyors asked patients to quantify their preoperative and postoperative alcohol intake. Patients were also asked about how alcohol affected them both before and after surgery.

“We decided to ask about quantity and frequency rather than specific symptoms of alcohol abuse,” Dr. Sogg said. “That’s because we felt patients would be more comfortable reporting quantitative data rather than answering more subjective questions about their drinking.”

More than two thirds of participants said they were affected more by alcohol after surgery than before, she said.

Problem drinking was defined as consuming at least 3 drinks per day on at least 4 days per week, or having 5 or more drinks on at least 2 days per month.

“We found a significant increase in risk of new-onset postsurgical alcohol abuse among these patients,” Dr. Sogg said.

They defined “remote” problem drinking as problem drinking that had ceased more than 6 months before surgery. If patients were having drinking problems within the 6 months before surgery, that was defined as “immediate” problem drinking, Dr. Sogg explained.

About 21% of participants reported having drinking problems at some point before surgery. In all, 15% reported a remote history and 6.5% reported having an immediate problem.

Approximately 9% of participants reported a period of problem drinking after their surgery. Problem drinking after surgery was associated with younger age (P = .040), longer time since surgery (P = .001), and a higher baseline body mass index (P = .049).

“Drinking problems within 6 months prior to surgery strongly predicted problem drinking after surgery,” Dr. Sogg said. The odds ratio was 6.59 (P = .0005).

However, a remote history of problem drinking was not associated with having drinking problems after surgery (odds ratio, 1.01; P = .99), she noted.

Of particular note, Dr. Sogg said, was that 7% of patients surveyed reported new-onset problem drinking after RYGB.

However, no clinical or demographic variables were identified as predictors of new-onset drinking problems.

“In the population as a whole about 90% of alcohol problems develop before the mid-30s,” Dr. Sogg said. “The mean age of our sample was 46. So it’s troubling to find how relatively common new-onset alcohol problems were in this population of patients.”

Another observation Dr. Sogg said she has made over the years — but didn’t include in the present study — is how quickly drinking problems seem to progress in post-surgery patients. “Alcohol abuse is usually a gradual-onset problem, but in many of our patients who develop drinking problems, it seems to rapidly ramp up, escalating very quickly.”

On the basis of her study results, Dr. Sogg said clinicians need to increase their focus on the potential of alcohol-related RYGB complications. “That means better patient education, better screening, and better efforts at prevention, both before and after surgery,” she said.

“I think what this study clearly tells us is that alcohol can be a problem after surgery for some of these patients. And we especially need to watch people who had problems with drinking up to the time of surgery,” said Leslie Heinberg, PhD, director of behavioral sciences at the Bariatric and Metabolic Institute, Cleveland Clinic, Ohio, in an interview with Medscape Medical News.

She emphasized, however, that patients in the study who reported a remote history of alcohol problems before surgery were not at increased risk for postoperative drinking problems.

Dr. Heinberg, who is also associate professor at the Cleveland Clinic Lerner College of Medicine, said that in their program she and her colleagues are very careful to counsel all their patients about the physiologic changes that take place during surgery and how those changes will make patients permanently more susceptible to alcohol.

“We make sure they understand that if increased susceptibility is something that’s likely to create problems for them, they might want to reconsider having the surgery,” she said.

Dr. Sogg and Dr. Heinberg have disclosed no relevant financial relationships.

Obesity 2011: The Obesity Society 29th Annual Scientific Meeting; Abstract #21-OR. Presented October 5, 2011

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Peripheral Neuropathy After Gastric Bypass Surgery

Peripheral Neuropathy has been increasingly on my radar, with respect to side effects related to nutrient deficiencies in gastric bypass patients.   This started for me a couple of years ago when my real good friend contacted me out of the blue.  He had gastric bypass surgery less than a year after I did from the same surgeon.   He emailed me out of concern to let me know he had been diagnosed with something called peripheral neuropathy.     How he figured this out was he was shopping in the local home improvement store and then all of a sudden experienced this extreme pain in his legs, to the point he didn’t think he would be able to make it out of the store.

What I soon learned was that peripheral neuropathy is a very serious and painful condition of the peripheral nervous system which is responsible for transmitting information from the brain and spinal cord to the rest of your body.    The Mayo Clinic found that as many as 16% of gastric bypass patients are developing nerve damage from problems associated with peripheral neuropathy.

The pain from neuropathy has been described as cutting, stabbing, crushing, burning, shooting, gnawing, or grinding, usually occurring on the extremities (arms and legs) .   Other symptoms of neuropathy include extreme numbness, paralysis, tingling, and burning.   In some cases, even just the weight of the bed sheet on the leg can trigger a pain event.    To heal or regrow nerves is a very slow and painful process.  This is definitely one of those cases – where an ounce of prevention is worth more than a pound of cure….

Think of peripheral nerves as the highways that transfer information back and forth from your extremities to the central nervous system (i.e., your big toe to your brain).    Information moves along the peripheral nerve electrically (which uses calcium, potassium and sodium as ions) and between other nerves (using neurotransmitters such as acetylcholine).  The nerve is protected by a sheath, which wraps around it and protects the fibers and keeps it from making abnormal transmissions.    When there is a breakdown anywhere in this process you can end up with a neuropathy.

There are many things that can cause neuropathies so it is often difficult to pinpoint the exact cause.   With that said, it is usually broken down to the following three causes:

  •  Acquired Neuropathies – caused by environmental factors such as toxins, trauma, illness , infection, alcoholism,  as well as poor nutrition and vitamin/nutrient deficiency
  • Hereditary Neuropathies
  • Idiopathic Neuropathies – unknown causes

In gastric bypass patients (or gastric bypass patients who have become alcoholics), the most obvious cause of acquired neuropathies is vitamin and nutrient deficiency.    Fortunately, peripheral neuropathies caused by nutrient deficiencies can be halted – even reversed – with vitamin/nutrient therapy.  The typical nutrient deficiencies associated with peripheral neuropathy are B1 (thiamine), B-12, copper or, strangely enough, an excess of B6 (pyridoxine).

Some of the nutrients that can then in turn be beneficial in alleviating the symptoms of peripheral neuropathy (if caused by vitamin/nutrient deficiency) are:

  • B-12 via injection (methylcobalamin or cyanocobalamin: methylcobalamin is the more absorbable of the two forms of B-12, so that may be the preferred form when recovering from peripheral neuropathy)
  • Vitamin B1 (thiamine)
  • Copper
  • Vitamin C
  • Multi-Mineral Supplement (that includes copper)
  • Co-Q10
  • Alpha Lipoic Acid

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