concerns of Gastric Bypass as opposed to the Sleeve, Vitamin retention, etc.

Question
Hi there
I have fibromyalgia and irritable bowel, and I had stage 4 endometriosis and stage 1a uterine cancer which resulted in a total hysterectomy last year.  They also removed my gallbladder as I had some very large stones.  I have had a few episodes of syncope, just so dizzy and then blacking out, and I have no idea why.  Suffice to say I am experiencing all the random symptoms of fibro and menopause, and I'm on a medical leave while we figure this out.  I'm truly healthy otherwise though I do have low iron and the fibro causes an alpha intrusive rhythm when I sleep which makes for poor quality, non restorative sleep.
My weight gain has been steady over the last five years and my bmi is now a 36 or 37 I believe.  My doctor referred me to a hospital in Etobicoke for Gastric Bypass, she is not sure if they do the sleeve, but either way she feels it will improve my fibro, my sleep, my pain if I can lose 80lbs.  I agree.  I am concerned about dumping, bowel blockage, vitamin deficiency, and fainting because I do faint more than the average person already and I have low blood pressure.  How do I determine whether to go for the bypass or the sleeve?  which allows for better vitamin and mineral retention and are there supplements I can take to ensure I'm good?    Thanks in advance for any advice you can give me.

Answer
Hi Heidi,

These are important questions to be asking - especially since you don't have a simple health history.

What you are now going to get is my opinion and others might disagree.

I would choose the gastric bypass. Sleeve gastrectomy as a primary procedure for weight loss is very new. In terms of nutrition, we have very few studies - however despite what some might tell you the early data does not look really any different from a gastric bypass. I expect over the long term, it will have its own pattern of deficiency and some things will be better and others (like bone loss) worse with a sleeve. Fundamentally, however, as a patient, the level of follow up and the types and amount of supplements you should have to take should be about the same.

In any surgical treatment for obesity, the goal with nutrition should be prevention as much as possible. So a question to already be thinking about for yourself is whether that is a commitment you can comfortable make for the rest of your life. It's not hard, but it's not simple either. There also a commitment to regular lab work and the possibility that you would develop a deficiency that might require treatment even if you do a great job with prevention.

So from a nutrition standpoint, I'd say the procedures are almost equal. The bypass is the better choice for the following reasons:

1) Experience - surgeons have been doing gastric bypass 3 times as long as they have been doing sleeve
2) Complications - there are much more dangerous complications like leaks and strictures that are a lot more common with sleeve - and harder to treat.
3) Sleeve patients often have protracted nausea which can make early good nutrition hard
4) With a sleeve, the permanently remove the majority of your stomach. It's gone forever. That part of your stomach in addition being volume for food, also makes the hormone ghrelin. Ghrelin is a major regulatory for centrally maintained bone density. In gastrectomy done for other reasons we know that we see very severe bone loss over the long term - probably due to this mechanism.
5) #4 also means that your procedure is never reversible.

So my feeling is to go with experience. Sleeve is the surgery "du jour" - gastric bypass is still the gold standard for a reason. Again - this is my opinion - but I would go with the procedure that we truly have the best understanding of if it were my own body.

I hope this helps! And good luck with your choice and your health in the future. The weight loss really does help with the other health issues you have and that should be a great advantage for you regardless. Also lowers your future cancer risk by a lot.

In Health,

Dr Jacques  

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