Addiction, Alcoholism, Gastric Bypass Surgery, Nutrient Deficiency and the Brain

In my last blog, I wrote about how they recently showed that gastric bypass surgery significantly increased your risk of developing alcoholism and substance abuse as well as suicide attempt and depression, much more so than merely restrictive procedures such as the lap-band.

Early on this was attributed to a psychological phenomena they called addiction transfer – theorizing that once a food addict could no longer eat they would “switch” to another substance in order to feel good.   It seemed to make sense.   Except to those of us who were experiencing it.  We knew things were different.   We felt “different”, “wrong”.  If this were truly psychological, we should see similar rates of this transfer among all weight loss surgeries:   duodenal switch, sleeve gastrectomy, lap-band, etc.

Many chemicals in the brain are responsible for that sense of well-being, your ability to feel happiness:  serotonin, dopamine, norepinephrine, endorphins.   But what about all the other nutrients your body must have in order for these chemicals to function properly?  They all work together.  Now what if those nutrients started to slowly diminish over time?  Say over the next 12-14 months? And longer?  How would you feel then?

What if you’ve suddenly achieved something you’ve yearned for, perhaps your entire life, and now find yourself having difficulty finding pleasure in things you know should find pleasure in?   Trying on new clothes?   Meeting new people?   Peoples reaction to the new you?   And what if that ability experience pleasure and joy just is not there.   You know it should be and it isn’t.   What if you start having trouble sleeping, maybe having anxiety, and you have no idea why?

And then you experience something and you feel “good” for the first time in a long time.   Maybe that something is alcohol, which if you’ve had gastric bypass, even a little bit might feel really good where before it was no big deal.   Or maybe your doctor writes you a prescription and you pop that pill and feel “good” again.  Or it might be shopping, etc…..   Or maybe you’re just one of those people that just tough it out and slog through and continue to feel awful.   The brain is incredibly amazing at associating what you need to not feel awful and is very crafty and effective at convincing you to keep it from feeling like crud all the time.

But I’m convinced that if the “feel good” chemicals in the brain had not been so deteroriated by the many months and months of depletion, so many people would not have vulnerable in the first place to this scenario.     There seems to be more understanding about how addiction works these days – the pleasure/reward pathways.   What I am hoping the scientific community starts to explore is where the breakdown is occuring.   How is this surgery creating the bio-chemical changes in our bodies that make a signficant population more vulnerable to addiction?

If this sounds at all familiar to your story, let me know.

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Why Is Gastric Bypass Surgery Causing Addiction, Alcoholism and Suicide but the Lap-Band Procedure Isn’t?

There was a study done by Dr. Magdalena Plecka Ostlund of the Karolinska Institutet in Stockholm showing that those people that had weight loss surgeries that bypassed the intestines had much higher rates of problems with addiction, depression, alcoholism and attempted suicide than those that had the Lap-Band (or similar type).

“The gastric bypass surgery cohort had higher Hazard Ratios (HR) than the restrictive surgery cohort for substance abuse (HR, 3.8), suicide attempt (HR, 4.1), alcohol abuse (HR, 4.0), and depression (HR, 2.4). For the restrictive surgery cohort, these HRs were, respectively, 1.4, 2.4, 1.2, and 1.8, she said.”

This report has been getting quite a bit of newspaper attention regarding the alcoholism component, and though indeed alcohol abuse is a big problem, there are also significantly large increases in problems in substance abuse, depression and suicide attempts. However, the important element in this story seems to be getting lost, Why isn’t this happening to the Lap Band group? I now would like to ask, can the data be further broken down among folks that had the sleeve gastrectomy without intestinal bypass? Would the Hazard Ratios still hold then? How about for duodenal switch?

Another factor is that the data is reported using Hazard Ratios. I don’t know about you, but I wasn’t exactly familiar with the term Hazard Ratios and what they meant in medical reporting, so of course I had to look it up. How I’ve come to understand hazard ratios is that after gastric bypass surgery, there would now be a 3.8 times increase in your risk of developing substance abuse over the control group (ie., those that didn’t have surgery). A Hazard Ratio of 1 would be the equal to the control group. So, the Lap Band group is only slightly greater than the normal population with regards to risk of alcoholism and substance abuse but not nearly like the gastric bypass group is.

For those suffering from any of these, I think it certainly bears more scrutiny as to why there is such a difference between procedures, both for the sake of prevention and treatment. If the cause could be pinpointed and studied, then perhaps the tragedies could be avoided.

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Gastric Bypass Surgery: Post-Operative Care with IV Nutrient Therapy and Injection Nutrient Therapy

I came across this interesting article.   I posted a similar one earlier when I found a local Naturopathic Doctor and started doing IV Nutrient Injection Therapy after gastric bypass surgery.

Gastric Bypass Surgery: Post-Operative Care with IV Nutrient Therapy and Injection Nutrient Therapy

By DR. Susan Williamson, NMD

With the rise of obesity in the U.S., more patients are turning to gastric bypass surgery to produce fast and dramatic weight loss. According to the Mayo Clinic, gastric bypass surgery is the most popular weight loss surgery in the United States. With gastric bypass surgery, the stomach is made smaller by reducing it to a thumb-sized pouch (15-30 mL or 1-2 tablespoons in volume), which considerably restricts the amount of food that can be eaten, as well as provide less surface area for the absorption of vitamins and minerals from food. In addition to this, the amount of hydrochloric acid (needed to absorb calcium and iron) and intrinsic factor (needed to absorb vitamin B12) produced by the stomach is greatly reduced due to its size, which also contributes to nutrient deficiencies. In addition to this, the duodenum, a major area of nutrient absorption within the intestinal tract may be bypassed depending on the type of procedure performed, further contributing to nutrient deficiencies.

Common symptoms of nutritional deficiencies are:

fatigue and weakness
hair loss and/or dry brittle hair
thin and brittle fingernails
difficulty thinking/concentrating
thinning of the skin/dry skin
softening/weakening of the bones (osteopenia/osteoporosis)
bone pain and bone deformities
muscle spasms
tooth discoloration and increased susceptibility to tooth decay
bleeding gums
increased tendency to bruise and bleed
anemia
sleep disturbances
neurological problems
pins and needles sensations in the body
permanent nerve damage
diarrhea
skin disorders
sore or swollen tongue
cracks at the edges of the mouth
swelling, usually in the legs
dehydration
decreased immune system strength, making an individual more prone to infections

Some nutrient deficiencies, if allowed to progress, can result in serious life threatening complications, so it is very important for gastric bypass patients to continue supplementing with nutrients and the best way to do this is via intravenous administration where the digestive tract is not a factor in the absorption of nutrients. With IV nutrient therapy, high doses of vitamins and minerals (much higher than what can be taken orally) can be delivered straight to the bloodstream where they are readily available to the cells for absorption and use by the body. People who have had gastric bypass surgery may also benefit from having specialty testing done at Bodhi Body Integrative Medical Centers to detect their specific nutrient deficiencies so that their particular nutrient deficiencies can be detected and therefore appropriately treated.

Common deficiencies of the fat-soluble vitamins (Vitamins A, D, E, and K) are common and these can be supplemented via intramuscular injection. Patients are at risk for developing anemia secondary to deficiencies of iron, Vitamin B12, and folate, all of which can be replenished easily via injection or IV. Calcium is a common nutrient deficiency as well due to the decreased stomach acid production in the reduced sized stomach. It is unknown whether gastric bypass patients can absorb the micronutrients selenium, zinc, and chromium, however these are included in the nutritional IVs as well as vitamin C, B12, B complex, B6, folate, calcium, magnesium, and electrolytes. Another benefit of the nutrient IVs is treatment of dehydration, which is another common symptom many suffer after gastric bypass surgery.

Patients who have nutrient deficiencies usually notice an immediate effect of feeling better after receiving a nutrient IV. If you or someone you know has had gastric bypass surgery then please contact Bodhi Body Integrative Medical Centers today so that we may assist you in replenishing your body’s nutrients and help prevent serious complications from developing and progressing. Taking oral vitamins and minerals will help some with nutrient deficiencies, however the severe deficiency that normally results after gastric bypass surgery is best treated with intravenous nutrients where gut absorption is not a factor and 100% of the nutrients is absorbed and available to the body.

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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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Intravenous MicroNutrient Therapy for Gastric Bypass Patients

When people who read my blog email me, they typically ask what they can do immediately to improve their nutrient deficiency. One of the procedures that I do that helps me maintain healthy nutrient levels is Intravenous MicroNutrient Therapy (IMNT). The most known of these is called the Myer’s Cocktail which was first created by Dr. John Myers, a Maryland physician who developed this process to treat his patients for a variety of conditions.  Dr. Alan Gaby, President of the American Holistic Medical Association, took over Dr. Myers patients after his death and has helped to popularize this treatment.

The contents of the basic Myer’s cocktail is magnesium, calcium, B12, B6, B5, B-complex, and Vitamin C.  My doctor customizes my treatment by adding selenium, zinc and a multi-trace mineral to the cocktail.   The cocktail can be administered via IV drip or IV push. I get the IV push. The procedure costs me $45 per treatment.

I started out with the first IMNT and then did another treatment one week later.  Now I go every 2-4 weeks depending on how I feel. When I received the first treatment she cautioned that I may notice a vitamin taste in my mouth during the procedure, but I felt nothing. However, during the next treatment a week later I could taste the vitamins almost immediately. My doctor explained that this was a sign that I was much more deficient the first time than the second.

The procedure can be a bit uncomfortable at times, but not painful. The injection must be done slowly. If it injected too quickly there is an uncomfortable pressure at the injection site. The needle is placed into the vein. The needle is connected to this very large syringe full of the nutrient solution by a long thin piece of tubing. The contents are then slowly injected. Like I wrote earlier, depending on your level of deficiency, you may or may not get this vitamin taste in your mouth right away. There is also a very warm flushing that comes over you caused by the magnesium sulfate solution (but goes away after the treatment is complete). The entire process takes 15-20 minutes. It is recommended that you arrive for this treatment very well hydrated.  I didn’t feel much improvement right away, but the next morning I was very peppy and in a great mood.

There aren’t very many studies regarding this process and gastric bypass patients. Most of the information I found was regarding patients that have been struggling with cancer related issues or fibromyalgia.

I have found this therapy a welcome adjunct to my daily supplement regimen. I feel this therapy provides me with that “cushion” of nutrients to cover for those days when I haven’t taken my supplements. I would also recommend this therapy as a jumpstart for those gastric bypass patients who have identified that they are experiencing extreme symptoms of nutrient deficiency and don’t want to wait for the daily oral supplements to take effect.

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How Nutrient Deficiency is Conducive to Creating Addiction?

I get the following question quite a bit “How do you think that malabsorption causes alcoholism/addiction?”, so I thought I’d make that the topic of today’s blog.

The malabsorptive component of many types of gastric bypass surgery can cause nutrient deficiency and as a recent study has shown, amino acid deficiency (caused by malabsorption of proteins).

This deficiency or deficiencies can lead to some very uncomfortable feelings including anxiety, rapid heartbeat, restlessness, fatigue, confusion, irritability (and others – see list below). Often our first instinct, when these feeling comes is to assuage them with food – our “old friend”. In the past, we may have found this to be a reliable method of providing immediate relief – albeit with a weighty side effect. We would often get a boost in serotonin or glucose or whatever and temporarily feel better. Now, post-gastric bypass surgery, we may find our old friend may or may not provide the relief that it used to.

Now we come to what I call the “double whammy” component – the way alcohol is now metabolized by the gastric bypass patient. A normal stomach has an enzyme called alcohol dehydrogenase that is responsible for metabolizing alcohol. After surgery, the new “little” stomach no longer has access to very much of this enzyme. The result is you get drunk faster and stay drunker longer.

A study by John Morton showed gastric bypass patients having progressively increased blood alcohol content as well as length of time to sober.    For example, Pre-operatively Blood alcohol was 0.024, at 3 months 0.059 and at 6 months 0.088.   Respectively, time to sober up was 49 minutes,  61 minutes and 88 minutes.   No explanation was offered as to the progessive nature of the findings.

So, let’s just say you are experiencing this uncomfortable feeling, and you decide to have a drink to “take the edge off”. It’s never been a problem before so it never occurs to you it will now. All of a sudden you get swift and immediate relief (dopamine floods your pleasure centers), unlike anything you ever got with snacking.   Your brain puts two and two together and very quickly starts telling you, you “need” this.

However, many gastric bypass patients weren’t drinkers at all and never turn to alcohol. Some decide to go to their doctor – makes sense right? Some medications that are often prescribed for these “uncomfortable feelings” are anti-depressants (Prozac, Zoloft, Effexor, Cymbalta, LexaPro, Celexa, Paxil …), anti-anxiety medications or benzodiazapenes (Xanax, Ativan, Valium, Klonipin), and/or sleep medications (Ambien, Lunesta, Sonata, Rozerem).  Benzodiazapenes are very addictive and in this situation, if you are masking a nutritional deficiency that will only get worse if uncorrected, it is easy to see how someone could quickly become addicted. Like alcohol, this drug will also supply quick and immediate (though temporary relief) and again the brain will realize this drug makes you feel better and want more.

Prescription pain medications are also something that may be readily available to the gastric bypass patient. In addition to the original gastric bypass surgery, the patient may have had other revision type surgeries such as hernia repair or a tummy tuck or gall bladder or something unrelated. For whatever reason, if experiencing this “dis-ease” (I call it), and then the patient takes an opiate pain medication (LorTab, Vicodin, Oxycontin, Percocet, Hydrocodone) and gets immediate relief, the brain puts it together and decides that “this is a really good thing” – it doesn’t think about the side effects – it just knows how much relief is being provided.

So the way this sets the gastric bypass patient up for addiction is by creating a scenario where the malabsorption changes the brain/body chemistry such that the person feels so “wrong” – that when whatever drug that person chooses provides that “right” feeling (be it alcohol “the double whammy”, prescription medication, gambling, shopping, sex), the brain re-wires itself to want more and more of whatever made it feel so “right”. So, I don’t think you can say this surgery makes you an addict, but perhaps, you can say it is conducive to optimizing the ideal circumstances where addiction can occur.

I think it’s important to avoid the nutritional deficiency in the first place, for many, many reasons – this being merely one. If you do notice those first “inklings” realize that is your body/brain telling you something.   Try to find out if you have any nutrient deficiencies if possible and nourish your body with the appropriate food and/or supplements. If you have already developed an addiction, seek help and professional assistance.
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Website with list of nutrients and associated symptoms
http://bariatricfusion.com/nutritionaldeficiency.php
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