(13-10-11) The Truth About Bariatric Surgery You Must Know

by David Juan, MD

This is the first of three parts on a very important subject: bariatric surgery. This short series will examine how it impacts your nutrient levels. Let's start with an overview.

With 31% of men and 33% of women being obese in the United States, the problem is an epidemic. Today, morbid obesity affects one in 50 adults. The most alarming trend may be the rising incidence of obesity among children.

While drugs and behavior therapy have had poor results, bariatric surgery for obese people can help sustain weight loss and treat related problems such as sleep apnea, asthma, diabetes, and clogged arteries. More than 140,000 bariatric surgeries are performed annually in the U.S. In the future, that number is set to rise three-fold.

There are three common procedures. To understand the nutritional complications involved, it's important to know how your gastrointestinal tract is altered by the surgeries.

1. Laparoscopic Adjustable Gastric Banding: This involves an inflatable silicone band placed around the upper part of the stomach. It creates a small gastric pouch. The band partially blocks food from passing -- thus restricting nutrients.

2. Short Limb Roux-en-y Gastric Bypass: This one creates a similar gastric pouch, also using a stapling device. The pouch is connected to part of the "jejunum" (the middle of the small intestine), bypassing the stomach and the first part of the jejunum. The person loses weight because the procedure restricts food intake and the absorption of fats and nutrients in those parts the pouch bypasses.

3. Biliopancreatic Diversion: This surgery creates a large stomach pouch connected to the "distal ileum" (the end of the small intestine), disrupting your absorption of many nutrients.

Now, where are nutrients absorbed in the digestive tract? Knowing will help you appreciate complications after bariatric surgery. Here are the regions of the tract and the things they are responsible for absorbing. (The duodenum, jejunum and ileum are the first part, middle part and end part of the small intestine, respectably.)
? Stomach: Water and minerals (molybdenum, fluoride, iodide, cooper)
? Duodenum: Vitamins (thiamin, riboflavin, niacin, biotin, folate, A, D, E, K) and minerals (calcium, iron, phosphorus, magnesium, copper, selenium)
? Jejunum: Minerals (calcium, phosphorus, magnesium, iron, zinc, chromium, manganese, molybdenum), vitamins (A, D, E, K, C, B6, folate, biotin, pantothenate, niacin, riboflavin, thiamin), and amino acids
? Ileum: Vitamins (C, B12, D, K, folate), magnesium, bile salts, and acids
Sources:
Ogden C.L., et al., "Prevalence of overweight and obesity in the United States, 1999-2004," JAMA, 2006; 295: 1,549- 1,555.
Sturm R., "Increases in clinically severe obesity in the United States, 1966-2000," Arch. Intern. Med., 2003; 163: 2,146-48.
Maggard, M.A., et al., "Meta-analysis: surgical treatment of obesity," Ann. Intern. Med., 2006; 142: 547-59.

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