Today I woke up and I hit the scale and I hit the 100 pound mark!  I was SOAKING WET and right out of the SHOWER!  I am SO EXCITED!  I am now down to 249.  It has only been 5 months and 15 days since my surgery!  Thank GOD and my lovely WIFE that I have HAD this surgery.  I am just GRATEFUL that I went THROUGH with it and did not back out at the last minute like so many people I have heard of.  While I was somewhat trepidacious, I also knew that obesity WAS going to kill me EVENTUALLY.  It was BETTER to DIE TRYING to regain my health than to SUCCUMB to the eventual CERTAINTY that was the MISERY that I was facing with OBESITY.  I now have a CHANCE at a near normal life.  I did not HAVE that before!   All of this in only 5 and a HALF months!  It is AMAZING! 

I saw an interesting article in yesterday's paper that I thought I would share with everyone about a new procedure that is being cooked up for weight loss.  It seems to be basically a pacemaker type device that tricks the brain into thinking the stomach is full.  I figured that I would share this with folks.  The link to the article is here:  http://www.startribune.com/lifestyle/health/23610179.html?location_refer=Health%20+%20Wellness:highlightModules:3  .

It has been some time since I have posted to my blog and I just wanted to assure people that I AM alive.  I have been QUITE busy of late.  As of TODAY, July 15, 2008, I have lost 89 pounds since my surgery on March 1, 2008.  have been MUCH more active lately being able to actually move about without the debilitating pain I had been suffering from while carrying the extra weight.  I have even fixed up my bicycle and have been riding with the kids some.  It is funny how the tires will go FLAT while you DON'T use it but seem to stay aired UP while you DO.  There is some kind of sermon about SOMETHING concerning neglect there. 

I have been promising some folks a study about some information that I have been looking at regarding Aspartame.  I suffer from MIGRAINES.  It appears that I am unusually SENSITIVE.  This is NOT unusual for ME, since I seem to be unusual in MOST things!  I am fond of saying, "The only thing NORMAL on me is my HAT size."  It is almost a guarantee that if I go to see the doctor about something, he is going to tell me that SOME portion of my anatomy is abnormal in SOME way.  The pulse in my foot is found in a different place than where it normally should be.  The vein in my arm runs in a different direction than most people's and it is difficult for phlebotomists to draw blood unless they KNOW this.  My stomach was twice as large as normal (empty) when it was removed which means that it could hold THREE TIMES the volume of food that a NORMAL stomach would.  The list can go on.  I can't.  Unfortunately, this month has found me hit with the double whammy of being hit with computer troubles ( I have THREE computers down at home--YES, THREE--We DON'T share well) and pretty much CONSTANT severe migraines, PROBABLY brought on in PART by the computer problems (staring at the SCREEN all day trying to fix the damned things may be triggering them) and a possible SINUS infection.  The SHORT of this story is that I AM working on the Aspartame research. 

It seems that Aspartame is a Migraine trigger for me.  While I do not have the time to go into all of the details NOW, I do promise that as soon as I get things sorted out with all three of my main computers (I actually have more than a dozen--most I do NOT use but I keep trying to SELL them or give them to folks who could use them--Seems that NO-ONE wants an 8088 anymore--Go figure)  ;-) I will get the research and MY conclusions on what I found and what it means for the weight loss community as a WHOLE posted.  In the meantime, for those who come looking for the information that I had promised:  I ask that you be patient.  I am sorry but it was only due to my OWN quick thinking that I was even ABLE to save the information on DISK before I had to wipe my hard drive.  I now have to RESTORE my hard drive to FIND that information before I can even RESUME the research.  That is to be done AFTER I repair my computer.  I had a big fat drop of WATER from a leak in the roof land RIGHT SMACK DAB in the CENTER of my KEYBOARD on my little laptop!  I now have to replace the motherboard. 

I curse the former owner of this house on a regular basis.  He fancied himself a handyman.  I will admit, and READILY, that he was GREAT with woodwork.  There are some wonderful cabinets in the house made out of common plywood.  He was TERRIBLE with engineering, design, basic carpentry, plumbing and electrical!  He added an extra room onto the back of the house; what is called a "Texas Room" in these parts and is essentially an enclosed back porch.  He then added a NEW back porch.  To COVER all of this, he stretched the back roof by tying into the back of the roof on the house.  Instead of going to the PEAK of the house, at the main part of the house, he went to the peak of the attached garage and "Mother in Law's room" which then tied the back roof to the MIDDLE of the slope on the back of the house.  This leaves the back roof with a split pitch with PART of the roof at a 45 degree angle (which is something like a 9/12 pitch) and part of the roof  has a 3/12 pitch.  What the 9/12 and 3 /12 pitch MEANS for those that don't know, is that for every LINEAR LEVEL foot of roof traveled, the roof DROPS so many INCHES.  It is easily MEASURED by taking a LEVEL and a RULER or tape measure to your roof and measuring a foot out on the level while it is at level with one end resting on the roof and at the one foot mark, using the ruler or tape measure to find out how many inches the roof drops from level.  To be truly accurate, you would need to use a plumb bob, but these are just ROUGH estimates and good enough for my purposes at the moment.  Putting a roof on the house isn't exactly ROCKET science, for crying out loud.  A 3/12 pitch is TOO SHALLOW for a shingle roof.  It is too shallow for most METAL roofs.  It is ALMOST a FLAT roof.  A roof like that requires a SPECIAL type of METAL roof or a MEMBRANE roof.  The IDIOT who built the addition, put on SHINGLES!  When we BOUGHT the house, the roof was leaking like a sieve!  One of the conditions of our MORTGAGE was that we had to RE-ROOF the house!  I knew THEN that I need to do something OTHER than shingles, but I didn't have the MONEY to do the job RIGHT, so I did the BEST  damned shingling job I could.  It has lasted 8 years.  That was longer than  I expected.  NOW, I need to go BACK UP on the roof and do it RIGHT.  I would LOVE to do it in METAL!  I may be forced to do it in MEMBRANE.  It is HARD to find the right kind of metal roof where I live for the shallow pitch of this roof.  I don't think my wife will let me take the roof OFF of the house and REDO the WHOLE THING!  We could even add some attic ROOMS in the house by adding some room to the PEAK!  I don't think I can sell THAT job, though.  Alas, my cup is half empty.  ;-)  Oh, yeah, As I sit here banging away at my little damaged laptop using a USB Keyboard so that I can type this, I sit UNDER an umbrella that rests on some EAVES in my Great Texas Room where my laptop Lies at State.  I have purchased a motherboard from eBay to replace the damaged one and await it's arrival with baited breath.  In the MEANTIME, I am taking NO CHANCES!  I am PROTECTED from stray drops of falling water!

 

Intil I I can come back again, Have fun, Be patient, and EAT HEALTHY!

 

Hugh

I found THIS gem at  http://www.thinnertimesforum.com/post-op-gastric-bypass/8652-does-carbonation-really-stretch-our-pouches.html. It was a post written by a woman named Whitney  The ONLY changes that I have made to this document were to correct the typographical errors that the original poster had left in the original post.  NOTHING of the information that was presented was changed.  The website for the Newsletter that WROTE the document can be found HERE: http://www.beyondchange-obesity.com/.   The Document I found follows:

Okay - I subscribe to a small locally produced newsletter called "Beyond Change - Information Regarding Obesity and Obesity Surgery"

They are so small that they oftentimes take months to transfer current printed newsletters to their website, so I will hand type their most recent research on carbonated beverages here (please forgive any typos – I spell checked only, but didn’t re-read the whole thing). Forgive me as it is really long:

"Why Carbonated Beverages are "TABOO" after bariatric Surgery"
By: Cynthia Buffington, Ph.D

Did you drink carbonated soft drinks prior to your Bariatric surgery? Do you still consume carbonated soft drinks? Were you advised by your surgeon or his/her nutritional staff NOT to drink carbonated drinks after surgery? Do you understand why drinking carbonated beverages, even if sugar-free, could jeopardize your weight loss success and, perhaps even your health?

A carbonated beverage is an effervescent drink that releases carbon dioxide under conditions of normal atmospheric pressure. Carbonated drinks include most soft drinks, champagne, beer, and seltzer water. If you consume a soft drink or other carbonated beverage while eating, the carbonation forces food through the stomach pouch, reducing the time food remains in the pouch. The less time food remains in your stomach pouch, the less satiety (feelings of fullness) you experience, enabling you to eat more with increased risk for weight gain.

The gas released from a carbonated beverage may "stretch" your stomach pouch. Food forced through the pouch by the carbonation could also significantly enlarge the size of your stoma (the opening between the stomach pouch and intestines of patients who have had a gastric bypass or biliopancreatic diversion). An enlarged pouch or stoma would allow you to eat larger amounts of food at any one setting. In this way, consuming carbonated beverages, even if the drinks are diet or calorie free, may cause weight gain or interfere with maximal weight loss success.

Soft drinks may also cause weight gain by reducing the absorption of dietary calcium. Dietary calcium helps to stimulate fat breakdown and reduce its uptake into adipose tissue. Epidemiological and clinical studies have found a close association between obesity and low dietary calcium intake. Recent studies have found that maintaining sufficient amounts of dietary calcium helps to induce weight loss or prevent weight gain following diet.

The high caffeine in carbonated sodas is one way that drinking carbonated soft drinks may reduce the absorption of calcium into the body. Studies have found that caffeine increases urinary calcium content, meaning that high caffeine may interfere with the uptake of dietary calcium into the body. Keep in mind that one 12 oz. can of Mountain Dew has 50 mg of caffeine, and Pepsi and Coke (diet or those with sugar) contain 37 mg of caffeine each.

Colas, such as Pepsi and Coke (diet or with sugar), may also cause calcium deficiencies from the high amounts of phosphoric acid that they contain. Phosphate binds to calcium and the bound calcium cannot be absorbed into the body. Both animal and human studies have found that phosphoric acid is associated with altered calcium homeostasis and low calcium.

Drinking carbonated beverages may also reduce dietary calcium because these beverages replace milk and other nutrient-containing drinks or foods in the diet. Several studies report inverse (negative) relationships between carbonated beverage usage and the amount of milk (particularly children) consume.

Carbonated beverages, then, may reduce dietary calcium because of their high caffeine or phosphoric acid content or because drinking such beverages tends to reduce the consumption of calcium-containing foods and beverages. Such deficiencies in dietary calcium intake may be even more pronounced in Bariatric surgical patients.

Calcium deficiencies with Bariatric surgery have been reported following gastric restrictive and/or malabsorptive procedures. The reduced amounts of calcium with bariatric surgery may occur as a result of low nutrient intake, low levels of vitamin D, or, for patients who have had gastric bypass or the biliopancreatic diversion (with or without the duodenal switch), from bypass of the portion of the gut where active absorption of calcium normally occurs. Drinking carbonated beverages may further increase the risk for dietary calcium deficiencies and, in this way, hinder maximal weight loss success.

For all the reasons described above, including calcium deficits, reduced satiety, enlargement of pouch or stoma, drinking carbonated beverages, even those that are sugar-free, could lead to weight gain. Carbonated beverages that contain sugar, however, pose a substantially greater threat to the Bariatric patient in terms of weight loss and weight loss maintenance with surgery.

Sugar-containing soft drinks have a relatively high glycemic index, meaning that blood sugar levels readily increase with their consumption. The rapid rise in blood sugar, in turn, increases the production of the hormone, insulin.  That acts to drive sugar into tissues where it is metabolized or processed for storage. High insulin levels, however, also contribute to fat accumulation, driving fat into the fat storage depots and inhibiting the breakdown of fat.

Soft drinks with sugar are also high in calories. An average 12 oz. soft drink contains 10 teaspoons of refined sugar (40g). The typical 12-oz. can of soda contains 150 calories (Coke = 140 calories; Pepsi = 150; Dr. Pepper = 160; orange soda = 180; 7-up = 140; etc.). Soft drinks are the fifth largest source of calories for adults, accounting for 5.6% of all calories that Americans consume. Among adolescents, soft drinks provide 8%- to 9% of calories. An extra 150 calories per day from a soft drink over the course of a year, is equivalent to nearly 16 pounds and that weight gain multiplied by a few years could equate to "morbid obesity".

In addition to the adverse effects that carbonated drinks have on weight loss or weight loss maintenance, carbonated beverages may also have adverse effects on health. Soda beverages and other carbonated drinks are acidic with a pH of 3.0 or less. Drinking these acidic beverages on an empty stomach in the absence of food, as Bariatric patients are required to do, can upset the fragile acid-alkaline balance of the gastric pouch and intestines and increase the risk for ulcers or even the risk for gastrointestinal adenomas (cancer).

Soft drink usage has also been found to be associated with various other health problems. These include an increased risk for diabetes, cardiovascular disease, kidney stones, bone fractures and reduced bone density, allergies, cancer, acid-peptic disease, dental cavities, gingivitis, and more. Soft drinks may, in addition, increase the risk for oxidative stress. This condition is believed to contribute significantly to aging and to diseases associated with aging and obesity, i.e. diabetes, cancer, cardiovascular disease, liver disease, reduced immune function, hypertension, and more.

From the above discussion, do you now have a little better understanding of why your Bariatric surgeon or Bariatric nutritionist advised you NOT to consume carbonated sodas after surgery? Your Bariatric surgeon and his/her staff want to see you achieve the best results possible from your surgery – both in terms of weight loss and health status – and so do YOU. Consider the consequences of drinking such beverages now that you understand more clearly why such drinks are "Bariatric taboo".

I can't take credit for THIS. it was COPIED pretty much verbatim DIRECTLY from the website given in the introduction.  I hope this helps clarify MY stance on drinking carbonated beverages.  NOTICE that it was WRITTEN by someone with a PhD and NOT a LAWYER.

Hugh

THIS is only PART of a document that refers to SPORTS drinks for athletes but I think it BOLSTERS my argument in part.  I found it at:
http://www.humankinetics.com/products/showexcerpt.cfm?excerpt_id=3204  .

You can read the whole article there if you want to ensure that I have not changed anything or have taken it out of context.  My point regarding this issue is that if there is bloating in the stomach then there is PRESSURE in the stomach.  If there is pressure in the stomach, then that pressure can cause the stomach lining to stretch.  The quote starts HERE:

Regarding the carbonation issue, consider that part of your body’s natural process of producing energy relies on the oxygen (O2) you breathe. A byproduct of the process is carbon dioxide (CO2). You don’t want a lot of carbon dioxide in your system because it’s poisonous to cells. It’s important to eliminate the excess, which you generally do through normal cardiovascular processes (blood flow and heart action) and respiratory processes (breathing). Endurance athletes, such as marathon runners, however, demand more than normal functioning from the body. When you push hard aerobically for an extended period of time, you tax your body’s ability to eliminate excess carbon dioxide, and you face a potential CO2 buildup. As your body works to eliminate the extra CO2, don’t choose a recovery drink that’s carbonated—that is, a beverage made bubbly by the infusion of CO2 gas. Ironically, you will sometimes see beverage companies offering bubbly drinks during and after races. At the very least, dilute any carbonated beverage by adding an equal amount of water before your drink it. Otherwise, beware of the most obvious negative reaction: carbonation can cause stomach bloating. In short, you may feel lousy in addition to the beverage not providing the benefits you seek. (End Quote)

Now, I am not saying that ONE can of Pepsi is going to KILL you.  I , however, was drinking up to 3 to four LITERS of DIET carbonated beverages a DAY in an effort to quench my hunger pangs and my sweet tooth.  When I spoke to my Surgeon and asked how BIG my stomach was when he pulled it out, he took out a pad of paper from his desk that was about the size of my hand or approximately 2/5ths the size of a normal sheet of printer paper and said, "This is about the size of a normal stomach."  He then took a sheet of paper from the printer that was next to him on his desk and put it next to the pad and said, "This is about the size your stomach was when we took it out."  He then took that SAME piece of paper and rolled it up short-ways into a tube about the size of my thumb and said, "This is the side of your stomach NOW."  This is the man that has pretty much turned my life around.  HE was the one that originally TOLD me that much of America's obesity problem is most likely DUE to the consumption of carbonated soft drinks to begin with.  He was the man that TOLD me that the carbonation was responsible for the stretching of the stomach in many people and thus causing more Americans to overeat.  Frankly, I don't need much more proof than THAT but an argument on the boards has caused me to search for more information so that I can be prepared for the next confrontation.  I shall continue in my search for more support to bolster my side in the argument but I do have a life, so it may be slow going.  

I have done an experiment at home.  Intuitively I knew that twice the surface of the stomach on the OUTSIDE meant that it would hold about THREE times as much FOOD on the INSIDE.  I couldn't remember the mathematical FORMULA that would PROVE my hunch so I did the next best thing I could think of.  I TESTED my hypothesis!  I took a piece of paper and folded it in half.  I stapled it together and then placed an EMPTY Minute Maid Light Lemonade can in the resulting "pouch."  There was enough room left over for two small medicine bottles so I put THOSE in TOO.  I was then able to pinch the pouch shut and "Seal" the "Stomach" thus enclosing the contents.  The "Normal" size stomach that I had created could hold a 12 ounce can and 2 small pill bottles.

I then took TWO sheets of regular sized printer paper and stapled them together.  I was able to place THREE 12 ounce cans and two MEDIUM sized pill bottles in the "Distended times 2" stomach.  While I am sure that this is not an ACCURATE approximation and that there is a more accurate way to do this it does come CLOSE to showing that a stomach that is TWICE the normal size when it is removed and deflated actually holds MORE than twice the normal amount of food.


I found a scientific article dealing with some experiments that dealt with EXACTLY what I am talking about but it is difficult for the layman to read. Basically the article talks about experiments on RATS that were performed regarding Gastric distension or to put it simply, the stretching of the stomach lining. The experiments were done to see how the pyloric valve affects the distention of the stomach.  This has been one of the focuses of my argument about the consumption of carbonated beverages. The article can be found HERE:

http://jp.physoc.org/cgi/content/full/533/3/801

To simplify what was written, the article starts off by stating that, "The pylorus (a valve in the bottom of the stomach that opens and closes to allow food and liquid to pass into the intestines and the rest of the digestive tract (a more in depth description can be found HERE: http://en.wikipedia.org/wiki/Pylorus) plays an important role in the regulation of gastric emptying. In addition to the autonomic neuropathy associated with long-standing diabetes, acute hyperglycaemia per se has effects on gastric emptying. In this study, the role of the central nervous system in modulating the effects of hyperglycaemia (High Blood Sugar or Diabetes More can be found Here: http://en.wikipedia.org/wiki/Hyperglycemia) on gastric distension-induced pyloric relaxation was investigated." The next few sentences basically tell of the various ways that they induced the rats to maintain the gas pressure in their stomachs instead of allowing the pressure to be released as it NORMALLY would be in a healthy rat. The researchers used various methods including cutting the vagus nerve to the stomach; neural receptor antagonist hexamethonium (more info HERE: http://en.wikipedia.org/wiki/Hexamethonium ) that targeted the nervous system and specific organs, In this case it was probably used for it's side effects on the stomach; N ^G-nitro-L-arginine methyl ester (more can be found on this compound here: http://content.karger.com/ProdukteDB/produkte.asp?Doi=47121) was used to limit the permeability of the stomach lining.

After setting the stage with all of this by creating the conditions similar to those found in the average diabetic person, they set the experiment up by inducing sleep with anesthesia and used an IV drip to administer to the rats a solution of sugar water that contained 20% sugar.  They allowed this to drip for 30 minutes which increased the sugar levels in the rats' blood from 5.4 to 12.8 mM. This, "significantly inhibited gastric distension-induced pyloric relaxation." In other words, it caused the pyloric valve to "tighten up" (this would cause any gasses trapped in the stomach to REMAIN in the stomach and NOT be expelled as they would in a healthy human).  A DIRECT injection of sugar water to the BRAIN did the same thing.

These higher blood sugars also had an effect on a brain neurotransmitter called hypothalamic neuropeptide Y (more on this found here: http://www.ncbi.nlm.nih.gov/pubmed/7479313).  It increased this neurotransmitter and it seemed to be responsible for a reduction in the production of insulin (that last observation is mine based on the research I saw that can be found at the site listed above). Introducing the neurotransmitter hypothalamic neuropeptide Y into the brain directly also caused the pyloric valve to "tighten up" and not allow the trapped gasses in the stomach to escape.

The introduction of a neuropeptide receptor antagonist (Y1 receptor antagonist, BIBP 3226) and a neuropeptide antibody (titre 1:24 000, 3 l) caused the symptoms caused by the increased blood sugars in the body and brain and the increased levels of hypothalamic neuropeptide Y in both the body and brain to be reversed.

The researchers concluded the abstract by saying, "Taken together, these findings suggest that gastric distension-induced pyloric relaxation is mediated via a vago-vagal reflex (more information here: http://en.wikipedia.org/wiki/Vagovagal_reflex) and NO release. Acute hyperglycaemia stimulates hypothalamic NPY release, which, acting through the Y1 receptor, inhibits gastric distension-induced pyloric relaxation in rats exposed to acute elevations in blood glucose concentrations."

Basically, in simple terms, this means that the experiment found that stomach stretching is caused by a tightened pyloric valve caused by damage to the vago-vagal reflex (a part of the vagus nerve). This in turn causes the blood sugar to rise and stimulate the hypothalmus gland to release a neuropeptide that causes even more tightening of the pyloric valve in rats exposed to high blood sugar levels.

The MEAT of the article goes on to say that basic health of the pyloric valve plays a big part in making sure that the stomach empties properly. The study mentioned that mice with a certain gene (nNOS gene) severely depleted developed severely enlarged stomachs with greatly enlarged pyloric valves. Partial paralysis of the stomach known as gastroparesis (more here: http://medical.merriam-webster.com/medical/gastroparesis) can cause nausea, abdominal pain, bloating, the feeling of fullness early in the meal, belching, anorexia, and vomiting. The article goes on to say that the most common CAUSE of this condition is diabetes. They state that getting control of the diabetes often can reverse the symptoms of the disease. The article mentions that tests done on humans showed similar results to those using the rats using, "a test meal in human volunteers."

The article states several times that the researchers don't fully understand many of the reasons for some of the results that they saw. They do not understand how high blood sugar impairs Gastrointestinal motility for example.

The article then goes into detail about how the experiment was conducted and what was discovered. Most of the details are discussed earlier and pretty much too boring to go into detail about. if you are interested in looking at them go HERE: http://jp.physoc.org/cgi/content/full/533/3/801 .

The article stated that "disordered motility in diabetes mellitus" or to put it simpler, messed up intestinal movement in diabetes has been "Traditionally" said to be caused by irreversible nerve damage to the "control system" or autonomic nervous system. Recent studies have shown that High Blood Sugar levels, "causes a reversible impairment of motility in various regions of the GI tract." or more simply put, the problem can be fixed in certain areas of the Gastrointestinal tract by simply lowering blood sugar levels. The article suggests that High Blood sugar levels or "Diabetes" can indeed affect how the stomach empties and whether or not gas can remain trapped and cause the stomach to expand.

The study concludes that control of the pyloric valve is primarily under the control of the vago-vagal reflex (or nerves that are related to the Vagus nerve and act as a control system for the body) and the release of Nitric Oxide (more information found here: http://en.wikipedia.org/wiki/Nitric_oxide) from the myenteric plexus (found here: http://en.wikipedia.org/wiki/Auerbach's_plexushttp://cancerweb.ncl.ac.uk/cgi-bin/omd?myenteric+plexus). It also discards the possibility that the tests results were due to swelling of the pyloric valve due to a super sponge like ability of the pyloric valve to soak up the sugar water or as the researchers put it, "This effect was not due to hyperosmolarity, since I.V. infusion of mannitol did not have any effect." The study goes on to say that High Blood Sugar Levels have no effect on the vagas nerve when it is stimulated to cause the pyloric valve to relax. The study also says that relaxation of the pylorus using neurotransmitters was also not effected by increasing the concentration of sugar water in vitro (in the controlled environment of the test tube). The authors of the article postulate that this suggests that this means that the High Blood Sugar Levels are causing these problems elsewhere because of the results shown in the tests mentioned in this last chapter. They also noticed that the effects were noticed after injecting sugar into the BRAIN and not injecting sugar into the body itself. They believe that this means that the effects are due to the High Blood Sugar’s effects on the Central Nervous System rather than the system that is localized around the stomach itself. 

I found this NEXT bit of the article to be MOST enlightening, "Williams and colleagues have demonstrated that NPY concentrations in the hypothalamus are significantly increased within 3 weeks of sustained hyperglycaemia in streptozotocin (STZ)-induced diabetic rats, and elevated concentrations of NPY in the hypothalamus in diabetic rats have been suggested to be responsible for diabetic hyperphagia (check here for a definition: http://medical-dictionary.thefreedictionary.com/hyperphagia) (Williams et al. 1988). The present study demonstrates that NPY concentrations in the hypothalamus were also significantly increased following acute hyperglycaemia in rats."

Basically what THIS is saying is that a neurotransmitter named NPY (more found here: http://en.wikipedia.org/wiki/Neuropeptide_Y) are increased in these diabetic rats and sustained for 3 weeks. It is suggested by the article that these elevated levels of neurotransmitters may be responsible for excessive hunger in diabetics.

I am going to let the authors speak for themselves first for the conclusion of this part of MY article. I will then put what was said into simpler terms for those who find the scientific jargon too hard to follow. The authors’ conclusion finishes with these two paragraphs: "It is concluded that hyperglycaemia stimulates NPY release in the hypothalamus and inhibits vagal activity via the hypothalamic NPY Y1 receptor in anaesthetized rats. Reduced vagal efferent (definition HERE: http://en.wikipedia.org/wiki/Efferent_nerve ) activity in the setting of acute hyperglycaemia decreases release of NO from the myenteric plexus (Definition Here: http://en.wikipedia.org/wiki/Auerbach's_plexus) and results in impaired pyloric relaxation and delayed gastric emptying.

The present study suggests that the hyperglycaemia associated with diabetes mellitus may have acute effects on gastric emptying. These effects are in part mediated (Definition Here: http://www2.merriam-webster.com/cgi-bin/mwmednlm) by the actions of NPY in the central nervous system. The deleterious effects of hyperglycaemia on gastric motility emphasize the importance of rigorous metabolic control in the management of diabetes."

Translated to layman’s terms that means that the authors of the article say that High Blood Sugar Levels cause the neurotransmitter called NPY to be released into the hypothalamus which is a region of the brain that links the nervous system to the pituitary gland. This in turn inhibits or restricts the activity of the vago-vagal reflex nerve fibers through the neurotransmitter receptors in the hypothalamus of anesthetized rats. They further say that reduced activity in the Vagal nerve due to High Blood Sugar Levels decreases the release of Nitric Oxide from the myenteric plexus (Definition Here: http://en.wikipedia.org/wiki/Auerbach's_plexus). The authors go on to say in the second paragraph that the High Blood Sugar levels associated with Diabetes may have severe effects on the stomach’s ability to empty. They say that these effects are in part caused by the neurotransmitter called NPY which acts as a transmission agent and a causal agent on the central nervous system. They say that the harmful effects of High Blood Sugar on the intestinal system’s ability to move food brings to light the importance of strictly controlling the Blood Sugar Levels of all Diabetics.

Here Is some MORE information that I have found on Gastroparesis.  The site that I located this information is located HERE:  http://digestive.niddk.nih.gov/ddiseases/pubs/gastroparesis/ .

The people who set up the site are listed below.
  

The site is:

What is gastroparesis?

Gastroparesis, also called delayed gastric emptying, is a disorder in which the stomach takes too long to empty its contents. Normally, the stomach contracts to move food down into the small intestine for digestion. The vagus nerve controls the movement of food from the stomach through the digestive tract. Gastroparesis occurs when the vagus nerve is damaged and the muscles of the stomach and intestines do not work normally. Food then moves slowly or stops moving through the digestive tract.

I would like to interject HERE to state that according to the study ABOVE, this is the OLD way of looking at the problem.  The research that was done in the study above showed that not ALL of the cases of Gastroperesis were caused by PERMANENT damage to the vagus nerve and that many, if not MOST of the cases could in fact be REVERSED by simply lowering the blood glucose level for a sufficient period of time (approximately 2 weeks).  This would cause the levels of neurotransmitter NPY 1 to drop and allow the Vagus nerve cluster to resume functioning as normal.

The digestive system

What causes gastroparesis?

The most common cause of gastroparesis is diabetes. People with diabetes have high blood glucose, also called blood sugar, which in turn causes chemical changes in nerves and damages the blood vessels that carry oxygen and nutrients to the nerves. Over time, high blood glucose can damage the vagus nerve.

Again, I would like to interject here that the study above suggests OTHER possible secondary causes for gastroperesis.  The INITIAL cause is not in debate.  The high blood sugars are indeed one of the main triggers for gastroparesis.  The SECONDARY causes are what is at debate here.  The old style of thought claims that the high blood sugar levels cause permanent damage to the nerves.  There MAY be some cases where that has happened.  I don't claim to be a medical expert.  According to the research above, the nerves are NOT permanently damaged in many cases and can RESUME their normal function after the blood sugar levels have been maintained for a short period of time (again, about 2 weeks).

Some other causes of gastroparesis are

• surgery on the stomach or vagus nerve
• viral infections
• anorexia nervosa or bulimia
• medications—anticholinergics and narcotics—that slow contractions in the intestine
• gastroesophageal reflux disease
• smooth muscle disorders, such as amyloidosis and scleroderma
• nervous system diseases, including abdominal migraine and Parkinson’s disease
• metabolic disorders, including hypothyroidism

Many people have what is called idiopathic gastroparesis, meaning the cause is unknown and cannot be found even after medical tests.

What are the symptoms of gastroparesis?

Signs and symptoms of gastroparesis are

• heartburn
• pain in the upper abdomen
• nausea
• vomiting of undigested food—sometimes several hours after a meal
• early feeling of fullness after only a few bites of food
• weight loss due to poor absorption of nutrients or low calorie intake
• abdominal bloating
• high and low blood glucose levels
• lack of appetite
• gastroesophageal reflux
• spasms in the stomach area

Eating solid foods, high-fiber foods such as raw fruits and vegetables, fatty foods, or drinks high in fat or carbonation may contribute to these symptoms.

The symptoms of gastroparesis may be mild or severe, depending on the person. Symptoms can happen frequently in some people and less often in others. Many people with gastroparesis experience a wide range of symptoms, and sometimes the disorder is difficult for the physician to diagnose.

What are the complications of gastroparesis?

If food lingers too long in the stomach, it can cause bacterial overgrowth from the fermentation of food. Also, the food can harden into solid masses called bezoars that may cause nausea, vomiting, and obstruction in the stomach. Bezoars can be dangerous if they block the passage of food into the small intestine.

Gastroparesis can make diabetes worse by making blood glucose control more difficult. When food that has been delayed in the stomach finally enters the small intestine and is absorbed, blood glucose levels rise. Since gastroparesis makes stomach emptying unpredictable, a person’s blood glucose levels can be erratic and difficult to control.

How is gastroparesis diagnosed?

After performing a full physical exam and taking your medical history, your doctor may order several blood tests to check blood counts and chemical and electrolyte levels. To rule out an obstruction or other conditions, the doctor may perform the following tests:

• Upper endoscopy. After giving you a sedative to help you become drowsy, the doctor passes a long, thin tube called an endoscope through your mouth and gently guides it down the throat, also called the esophagus, into the stomach. Through the endoscope, the doctor can look at the lining of the stomach to check for any abnormalities.

• Ultrasound. To rule out gallbladder disease and pancreatitis as sources of the problem, you may have an ultrasound test, which uses harmless sound waves to outline and define the shape of the gallbladder and pancreas.

• Barium x ray. After fasting for 12 hours, you will drink a thick liquid called barium, which coats the stomach, making it show up on the x ray. If you have diabetes, your doctor may have special instructions about fasting. Normally, the stomach will be empty of all food after 12 hours of fasting. Gastroparesis is likely if the x ray shows food in the stomach. Because a person with gastroparesis can sometimes have normal emptying, the doctor may repeat the test another day if gastroparesis is suspected.

Once other causes have been ruled out, the doctor will perform one of the following gastric emptying tests to confirm a diagnosis of gastroparesis.

• Gastric emptying scintigraphy. This test involves eating a bland meal, such as eggs or egg substitute, that contains a small amount of a radioactive substance, called radioisotope, that shows up on scans. The dose of radiation from the radioisotope is not dangerous. The scan measures the rate of gastric emptying at 1, 2, 3, and 4 hours. When more than 10 percent of the meal is still in the stomach at 4 hours, the diagnosis of gastroparesis is confirmed.

• Breath test. After ingestion of a meal containing a small amount of isotope, breath samples are taken to measure the presence of the isotope in carbon dioxide, which is expelled when a person exhales. The results reveal how fast the stomach is emptying.

• SmartPill. Approved by the U.S. Food and Drug Administration (FDA) in 2006, the SmartPill is a small device in capsule form that can be swallowed.The device then moves through the digestive tract and collects information about its progress that is sent to a cell phone-sized receiver worn around your waist or neck. When the capsule is passed from the body with the stool in a couple of days, you take the receiver back to the doctor, who enters the information into a computer.

How is gastroparesis treated?

Treatment of gastroparesis depends on the severity of the symptoms. In most cases, treatment does not cure gastroparesis—it is usually a chronic condition. Treatment helps you manage the condition so you can be as healthy and comfortable as possible.

Medication

Several medications are used to treat gastroparesis. Your doctor may try different medications or combinations to find the most effective treatment. Discussing the risk of side effects of any medication with your doctor is important.

• Metoclopramide (Reglan). This drug stimulates stomach muscle contractions to help emptying. Metoclopramide also helps reduce nausea and vomiting. Metoclopramide is taken 20 to 30 minutes before meals and at bedtime. Side effects of this drug include fatigue, sleepiness, depression, anxiety, and problems with physical movement.

• Erythromycin. This antibiotic also improves stomach emptying. It works by increasing the contractions that move food through the stomach. Side effects include nausea, vomiting, and abdominal cramps.

• Domperidone. This drug works like metoclopramide to improve stomach emptying and decrease nausea and vomiting. The FDA is reviewing domperidone, which has been used elsewhere in the world to treat gastroparesis. Use of the drug is restricted in the United States.

• Other medications. Other medications may be used to treat symptoms and problems related to gastroparesis. For example, an antiemetic can help with nausea and vomiting. Antibiotics will clear up a bacterial infection. If you have a bezoar in the stomach, the doctor may use an endoscope to inject medication into it to dissolve it.

• There is a relatively NEW treatment for gastroparesis that this text did not cover but that the study above suggested.  That treatment was Weight Loss Surgery.  Again, I must state that I am NOT a medical "Expert" but I am merely stating what the study suggested.

Dietary Changes

Changing your eating habits can help control gastroparesis. Your doctor or dietitian may prescribe six small meals a day instead of three large ones. If less food enters the stomach each time you eat, it may not become overly full. In more severe cases, a liquid or pureed diet may be prescribed.

I am again interjecting here to say that those of us who have HAD the weight loss surgery are FORCED to follow this suggestion of a changed pattern of eating behavior.  While we often do not resort to such extreme measures as the liquid or pureed diet for LIFE as suggested above, we usually (I do STRESS the word USUALLY) avoid the High FAT foods as suggested below.  Many of us DO try to eat a diet high in FIBER though.  I do not know how they would affect a person that suffers from Gastroperesis and has had Weight Loss Surgery.  Those issues were not addressed in the research.

The doctor may recommend that you avoid high-fat and high-fiber foods. Fat naturally slows digestion—a problem you do not need if you have gastroparesis—and fiber is difficult to digest. Some high-fiber foods like oranges and broccoli contain material that cannot be digested. Avoid these foods because the indigestible part will remain in the stomach too long and possibly form bezoars.

Feeding Tube

If a liquid or pureed diet does not work, you may need surgery to insert a feeding tube. The tube, called a jejunostomy, is inserted through the skin on your abdomen into the small intestine. The feeding tube bypasses the stomach and places nutrients and medication directly into the small intestine. These products are then digested and delivered to your bloodstream quickly. You will receive special liquid food to use with the tube. The jejunostomy is used only when gastroparesis is severe or the tube is necessary to stabilize blood glucose levels in people with diabetes.

Personally, I think I would try Weight Loss Surgery BEFORE going this route!  Just MY personal choice though. 

Parenteral Nutrition

Parenteral nutrition refers to delivering nutrients directly into the bloodstream, bypassing the digestive system. The doctor places a thin tube called a catheter in a chest vein, leaving an opening to it outside the skin. For feeding, you attach a bag containing liquid nutrients or medication to the catheter. The fluid enters your bloodstream through the vein. Your doctor will tell you what type of liquid nutrition to use.

This approach is an alternative to the jejunostomy tube and is usually a temporary method to get you through a difficult period with gastroparesis. Parenteral nutrition is used only when gastroparesis is severe and is not helped by other methods.

Gastric Electrical Stimulation

A gastric neurostimulator is a surgically implanted battery-operated device that releases mild electrical pulses to help control nausea and vomiting associated with gastroparesis. This option is available to people whose nausea and vomiting do not improve with medications. Further studies will help determine who will benefit most from this procedure, which is available in a few centers across the United States.

Again, I think I would try Weight Loss Surgery BEFORE going this route!

Botulinum Toxin

The use of botulinum toxin has been associated with improvement in symptoms of gastroparesis in some patients; however, further research on this form of therapy is needed.

What if I have diabetes and gastroparesis?

The primary treatment goals for gastroparesis related to diabetes are to improve stomach emptying and regain control of blood glucose levels. Treatment includes dietary changes, insulin, oral medications, and, in severe cases, a feeding tube and parenteral nutrition.

As the study above suggested, often controlling the diabetes will allow the person suffering from gastroparesis to control THAT as well.  If you are obese, the Weight Loss Surgery CAN be a VERY effective tool in getting your blood sugar BACK under control WITHOUT the use of medication.

Dietary Changes

The doctor will suggest dietary changes such as six smaller meals to help restore your blood glucose to more normal levels before testing you for gastroparesis. In some cases, the doctor or dietitian may suggest you try eating several liquid or pureed meals a day until your blood glucose levels are stable and the symptoms improve. Liquid meals provide all the nutrients found in solid foods, but can pass through the stomach more easily and quickly.

Once again, those of us who have HAD the weight loss surgery are FORCED to follow this suggestion of a changed pattern of eating behavior.  While we often do not resort to such extreme measures as the liquid or pureed diet for LIFE as suggested above.

Insulin for Blood Glucose Control

If you have gastroparesis, food is being absorbed more slowly and at unpredictable times. To control blood glucose, you may need to

• take insulin more often or change the type of insulin you take
• take your insulin after you eat instead of before
• check your blood glucose levels frequently after you eat and administer insulin whenever necessary

Your doctor will give you specific instructions for taking insulin based on your particular needs.

Hope through Research

The National Institute of Diabetes and Digestive and Kidney Diseases’ Division of Digestive Diseases and Nutrition supports basic and clinical research into gastrointestinal motility disorders, including gastroparesis. Among other areas, researchers are studying whether experimental medications can relieve or reduce symptoms of gastroparesis, such as bloating, abdominal pain, nausea, and vomiting, or shorten the time the stomach needs to empty its contents following a meal.

Points to Remember

• Gastroparesis is the result of damage to the vagus nerve, which controls the movement of food through the digestive system. Instead of moving through the digestive tract normally, the food is retained in the stomach.  this text as filler so that a bullet soes not show wOnce again I nInce again I Once again eOnceedhen  Once again I need to interject and state that this is the OLD way of looking at the problem.  According to the research above, not all the cases of gastroparesis would be caused by vagus nerve damage.  Many, if not MOST, would be caused by high blood sugar levels causing a rise in the neurotransmitter NPY1.

• Gastroparesis may occur in people with type 1 diabetes or type 2 diabetes. The vagus nerve becomes damaged after years of high blood glucose, resulting in gastroparesis. In turn, gastroparesis contributes to poor blood glucose control..   I will use this text as filler soOnce again I I Once again need tOncOncee again hat a Once again I need repeat what I stated above.

• Symptoms of gastroparesis include early fullness, abdominal pain, stomach spasms, heartburn, nausea, vomiting, bloating, gastroesophageal reflux, lack of appetite, and weight loss.

• Gastroparesis is diagnosed with tests such as x rays, manometry, and gastric emptying scans.

• Treatment includes dietary changes, oral medications, adjustments in insulin injections for people with diabetes, a jejunostomy tube, parenteral nutrition, gastric neurostimulators, or botulinum toxin.  The lateThe latest TreTHEThe  atstt  The Latesrt treatment  suggested for this disorder is Weight The Latest iweTH  The latest treatment suggested for this disorder is Weight Loss Surgery.  Once again, I must state that I am NOT a medical EXPERT.  I am merely stating what the research suggested.

The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.

THIS article (Disordered gastric motor function in diabetes mellitus by M. Horowitz and R. Fraser) states that , "Gastric emptying is abnormal in about 50% of diabetic patients." (The article can be found HERE: http://www.springerlink.com/content/t777t34672825073/). The full article follows:

Summary: The application of novel investigative techniques has demonstrated that disordered gastric motility occurs frequently in diabetes mellitus. Gastric emptying is abnormal in about 50% of diabetic patients and delay in gastric emptying of nutrient-containing meals is more common than rapid emptying. The blood glucose concentration influences gastric motility in diabetes. In IDDM patients, gastric emptying is retarded during hyperglycaemia and may be accelerated by hypoglycaemia. Gastroparesis therefore does not necessarily reflect irreversible autonomic neuropathy and blood glucose concentrations must be monitored when gastric motility is evaluated in diabetic patients. There is a poor relationship between gastric emptying and gastrointestinal symptoms and the mechanisms by which abnormal motility causes symptoms are unclear. The introduction of new gastrokinetic drugs has improved therapeutic options for the management of symptomatic patients with gastroparesis considerably. The contribution of disordered gastric emptying to poor glycaemic control is unclear, but the demonstration that the rate of gastric emptying is a major factor in normal blood glucose homeostasis suggests that this is likely to be significant.

Combine the 2 pieces of information and you have the possibility that there may be up to HALF of the uncontrolled diabetics suffering from gastroparesis with a large part of THOSE suffering from gastric distension due to pyloric valve problems caused by the diabetes itself.

I found another article about GERD and the role of role of the lower esophageal sphincter. The article is titled "Physiology of reflux disease: role of the lower esophageal sphincter" by P. F. Crookes (The full article can be found HERE:  http://www.springerlink.com/content/851h78051112m121/fulltext.html). In it the article mentions the historical struggle with understanding GERD and the influence of the disease on the creation of the current technology of laproscopic procedures. The article also comments that there are basically two schools of thought regarding GERD with one looking at the disease from the viewpoint of having the lower esophageal sphincter (LES) basically damaged to the point where it no longer keeps the stomach’s contents in place because it can no longer exert enough pressure and the other camp thinking of the disease as basically the contents of the stomach being pressurized to the point where the pressure overcomes the ability of the lower esophageal sphincter (LES) to contain the stomach’s contents any longer. The author of the article attempts to bring the 2 camps together and explains that they are like the six blind men in a poem by John Godfrey Saxe:

It was six men of Indostan

To learning much inclined,

Who went to see the Elephant

(Though all of them were blind),

That each by observation

Might satisfy his mind.

Each of the blind men grab a different part of the elephant and each describe something completely different than the other. Each believes that he has the "TRUE" picture of the elephant but he only has PART of the picture.

My concern with this article has little to do with GastroEsophageal Reflux Disease (GERD) but with one of the possible underlying causes mentioned in this article. I will take a PORTION of his article and quote it in it’s entirety. The numbers that you see in brackets in the quote are for references that the author used in his work. I have not copied them to my work. If you would like the references, follow the link above to get them from his article. There was also a figure that I did not include that is referenced in the article. If you want to see the figure, use the link above.

"We hypothesized that some elements of the modern diet predispose patients to reflux by reducing the resting parameters of the LES. One dominant feature of the western diet known to cause gastric distention is the consumption of carbonated beverages. Like many epidemiologic trends in this country, such as the incidence of reflux disease and obesity, the consumption of carbonated beverages is also greatly increasing. It is estimated that approximately 1.3 billion products of the Coca-Cola Company are drunk every day. The average American drinks 53 gallons of soft drinks per year. This environmental change is just one of many factors that could potentially contribute to the development of GERD.

We recently reported the changes that occur in the resting LES parameters after ingestion of carbonated beverages [24]. Although the situation is not completely physiologic, in that the examined subjects were lying flat on the manometry couch, there is a clear and consistent reduction of pressure, abdominal length, and overall length of the LES after ingestion of widely varied carbonated drinks, from cola with and without caffeine to sparkling water (Fig. 1). It has been known for a long time that many foodstuffs typical of a western diet cause a reduction in LES pressure, but no previous study showed a change in the morphology of the LES as a consequence of gastric distention. Experimental work by Mason et al. [25] produced similar changes in the morphology of the LES by inducing gross gastric distention in anesthetized baboons with the pylorus ligated. Because of the artificial environment in this animal preparation, the relevance of the findings to typical reflux has been disputed. The results of our study, however, indicate that an individual can induce similar morphologic changes by drinking a can of typical carbonated beverage, and because three beverages (cola, caffeine-free cola, and sparkling water) produced comparable effects, it seems intuitively likely that the presence of carbonation and distention of the fundus is responsible. We hypothesize that in patients with normal LES parameters studied in the laboratory, the consumption of these materials may reduce the resting LES status to a level normally regarded as defective if it occurs in a fasting patient. It is thus clear that LES pressure and length measured in a fasting patient represent the optimal performance of which the LES is capable. By extension, if the LES is found to be defective when measured in the manometry laboratory in the fasting state, it will deteriorate even further after a meal.

I will skip some stuff to another part of the article that interests me:

"Obesity

The contribution of obesity to GERD is controversial. It is widely believed to be causative, and most treating physicians faced with an overweight patient recommend weight loss as a part of their overall advice. Epidemiologic studies from the NHANES III survey and other more limited surveys, such as that from Olmstead County, Minnesota, have shown a stepwise increase in the reporting of GERD symptoms and patients admitted with a GERD-related diagnosis as body mass index (BMI) increases [29, 30]. However, the category of greatest weight was a BMI of 30 or higher, and there was no attempt to identify whether greater degrees of obesity produced a greater incidence of GERD. Contrary to widespread belief, we found that morbid obesity is rare among patients presenting to a foregut clinic (Fig. 3), and that the incidence of hiatal herniation was no greater among morbidly obese subjects than among healthy volunteers. It may well be that the prevalence of GERD follows a parabolic pattern with weight increasing to a BMI in the region of 30 kg/m², but that above this weight, serious reflux disease becomes rarer.

I postulate that the reason that they found fewer obese patients with GERD was that people with the stronger lower esophageal sphincter are not subject as often to GERD and keep the pressure INSIDE the stomach where it causes the stomach walls to distend. This distension of the stomach walls causes the stomach to grow ever larger and the patient to grow ever more obese as he consumes more carbonated beverages and food to fill the ever growing stomach. I am not a medical expert. But the evidence I have seen and put together here seems fairly convincing, I think.

Hugh

 

 

Take this for what it's worth.  I am telling you up front that I am NOT an "Expert" on Weight Loss Surgery.  I encourage EVERYONE to RESEARCH EACH surgical option FOR THEMSELVES!  THIS is the information that I have found in MY research.  I have posted it here for people in an effort to help GUIDE folks and help them START their OWN journey into their OWN research.

There are a LOT of differences in the different types of surgical procedures.  There are a LOT of differences in different SURGEONS.  Some surgeons require more of their patients than others.  Some PROCEDURES require more of the patient than others.  You need to do some research and find the BEST fit for YOU.  I just had a Vertical Sleeve Gastrectomy 3 weeks ago.  My surgeon did NOT require me to lose weight.  I had a BMI of 43.6.  Now that isn't NEARLY as bad as many people.  Had I been HEAVIER, he may HAVE required it.  I don't know.  What I CAN tell you is that I was having problems with arthritis in my knees and my shoulder.  That was three weeks ago.  Now it is almost GONE.  There is just a TWINGE every now and again but NOTHING NEAR the constant agony that I was in before!  I was also a Diabetic 3 weeks ago.  I have had to DROP all of my diabetes medications a few days ago because the ONE glucovance pill that I was taking caused me to have my blood sugar to DROP to 53 POINTS!  My sugars are still a LITTLE high, but under 150 and WITHOUT medication!  In a FEW weeks with some MORE weight loss, I figure that my diabetes will be in COMPLETE remission!  I have lost 36 pounds in a little over 3 weeks with my surgery and it was done WITHOUT feeling HUNGRY! 

Here is a link to a site on AOL that gives you a brief overview of the most common weight loss surgeries plus one that is not quite so common.  It will give you an idea of what these surgeries are about but does not go into much detail.  Here is the link:  http://www.aolhealth.com/condition-center/obesity/weight-loss-surgery?icid=1615984945x1203971396x1200410494 .

From what I have learned, your MAIN options are the LapBand, the Vertical Banded Gastroplasty, the Gastric Bypass, The Duodenal Switch and the Vertical Sleeve Gastrectomy.  There are other options, I am sure, but these are the most common that I have found.  There are also combinations of these options ALSO available such as the Banded Duodenal Switch, the Banded Gastric Bypass, and the Banded Sleeve Gastrectomy.  The Banded options are basically the same as the Regular surgeries but they have a LapBand added as additional insurance in case of future need.

The LapBand: (http://www.obesityhelp.com/content/wlsurgery.html#LapBand) is well known.  It basically squeezes the stomach to make it smaller and creates a pouch with a restriction at the top of the stomach which fills quickly and empties slowly.  The advantages of this surgery are that it is reversible if needed and it is adjustable if needed.  It is a HIGHLY flexible procedure.  This surgery is well known and excepted by many insurance companies.  It may be best for people who have a history of cancer either themselves or in their family and may need to take chemo-therapy and for women in childbearing years who may become pregnant.  There are also other reasons for wanting this type of surgery, but I don't want to spend ALL day writing this.  There is an effective Excess body weight loss over 3 to 5 years of 50% to 60% noted in some studies.  The PROBLEM with this option is that there are sometimes complications with this device.  Some people have a reaction to the foreign object in their body.  People with immune issues should NOT have this device.  Lupus and MS patients for example, can have a reaction to the foreign body and it may trigger an immune system response.  Other issues with the LapBand are that it is common for the band to "Slip" on the stomach and cause the pouch to enlarge thus causing the person with the device to eat more and negating the purpose of the surgery.  Some surgeons have started stitching the band to the stomach to prevent this from happening.  It would be wise to ask your surgeon if you are considering this option if he does this.  Other times people have learned to "Eat around the Band" and force the food PAST the band to fill up the rest of the stomach and thus defeat the purpose of the band.  Actually, this is an issue with ALL weight loss surgeries.  All can be defeated by a patient who is either ignorant or intent on doing so.  It seems to be MORE common with the Banded options, however.  Another issue with Banded options is that occasionally the bands will erode the outside lining of the stomach causing damage to the stomach that often needs repairs and calls for a removal of the band and or a revision to some other type of weight loss option.  This happens in about less than 1% of the LapBand Surgeries but it IS something that needs to be taken into consideration.

I have recently stumbled upon an EXCELLENT video showing an operation that features a LapBand Weight Loss Surgery!   CAUTION!  THE VIDEO IS GRAPHIC!  IF YOU HAVE A WEAK STOMACH, I SUGGEST that you just START the video and put it in the background somewhere and LISTEN!  There is some GREAT INFORMATION given during the procedure and I found it to be QUITE FASCINATING!  The link can be found HERE: 
http://www.or-live.com/duluthclinic/2040/event/rnh.cfm?

 In the Vertical Banded Gastroplasty: (http://www.obesityhelp.com/content/wlsurgery.html#VBG) (commonly known as stomach stapling) the surgeon makes a cut into the stomach to create a pouch.  He sews the pouch and places a band at the bottom of the pouch.  This banded option has less chance of the band slipping since the cut in the stomach holds it into place.  It also has the advantage of being somewhat reversible but is not as easily reversible as the LapBand.  It is NOT as well known as it's more famous banded cousin, the LapBand.  There my be difficulties in getting this option with some insurance companies.  It has many of the advantages and disadvantages of the LapBand surgery with the exception that the Band does not tend to slip and let the pouch expand.

An excellent link that better explains the pros and cons of this procedure than I can can be found here: http://obesitysurgerynjnyct.com/weight-loss-surgery-options.html.   It also discusses some of the other procedures to some extent.

 The Gastric Bypass:  ( http://www.obesityhelp.com/content/wlsurgery.html#RNY) is made when the surgeon cuts the TOP of the stomach off and creates a pouch.  An OLDER version of this surgery left the stomach intact but had a line of staples that was used to create the pouch.  This method is no longer in use much if at all.  The surgeon then takes a length of intestine and BYPASSES it.  He takes the LOOSE end that is still attached to the intestines and sews it to the SIDE of the pouch that was created from the TOP of the stomach.  The BYPASSED intestine is then attached to the side of the intestine that was connected to the pouch so that BILE from the bile duct can empty bile from the liver into the intestine.  This option is often the DARLING of insurance companies.  Many companies that won't pay for any OTHER Weight Loss Surgeries will pay for THIS one.  THAT makes THIS surgery quite popular for many surgeons!  This surgery has the advantage of being a HIGHLY effective tool in the arsenal of weapons against the foe obesity!  It has an effective rate of weight loss and maintenance of 60 to 80% in some studies at 1 to 2 years.   The DOWNSIDE of this weight loss option is that there issues of malabsortion of minerals and vitamins due to the bypassed intestine.   This often leaves the patient reliant on his doctor for the special supplements required to maintain his or her health.  Other issues are dumping, nausea, and vomiting.  Dumping is basically when you have diarrhea that is caused by the intestine's inability to absorb the food that was eaten.  Along with the diarrhea can come intestinal cramping, sweating, palpitations and other unpleasant side effects.  Some people experience dumping with sweets. Others experience it with fats.  Each person seems to have their own issues but whatever they are, they cause them to excrete the food that they ate before it was fully digested.  Nausea and vomiting, while experienced by many in ALL weight loss surgeries is NOT experienced by ALL.  It does seem to be MORE PREVALENT in the GASTRIC BYPASS and DUODENAL SWITCH patients according to the research that I have seen.  The gas and foul smelling stool are also a result of the shortened digestive process due to the bypassed intestine in both the Gastric Bypass and the Duodenal Switch.

I have recently stumbled upon an EXCELLENT video showing an operation that features a Gastric Bypass (otherwise known as the Roux-en-Y)!   CAUTION!  THE VIDEO IS GRAPHIC!  IF YOU HAVE A WEAK STOMACH, I SUGGEST that you just START the video and put it in the background somewhere and LISTEN!  There is some GREAT INFORMATION given during the procedure and I found it to be QUITE FASCINATING!  The link can be found HERE: http://www.or-live.com/PinnacleHealth/2119/event/rnh.cfm?

"Mini Gastric Bypass": 
This was quite popular a while back but there where problems that were soon discovered that KEPT the procedure from REMAINING a popular option. You can read MORE about this procedure at this site: http://ezinearticles.com/?Mini-Gastric-Bypass---The-Ideal-Weight-Loss-Solution&id=361143 . What follows is a direct copy of the entry for the post on the Mini Gastric Bypass in the section defining the procedure under the Variations of the Gastric Bypass in WikiPedia. "Loop Gastric bypass ("Mini-gastric bypass"): The first use of the gastric bypass, in 1967, used a loop of small bowel for re-construction, rather than a Y-construction as is prevalent today. Although simpler to create, this approach allowed bile and pancreatic enzymes from the small bowel to enter the esophagus, sometimes causing severe inflammation and ulceration of either the stomach or the lower esophagus. If a leak into the abdomen occurs, this corrosive fluid can cause severe consequences. Numerous studies show the loop reconstruction (Billroth II gastrojejunostomy) works more safely when placed low on the stomach, but can be a disaster when placed adjacent to the esophagus. Thus even today thousands of "loops" are used for general surgical procedures such as ulcer surgery, stomach cancer and injury to the stomach, but bariatric surgeons abandoned use of the construction in the 1970s, when it was recognized that its risk is not justified for weight management. The Mini-Gastric Bypass, which uses the loop reconstruction, has been suggested as an alternative to the Roux en-Y procedure, due to the simplicity of its construction, which reduced the challenge of laparoscopic surgery. It is claimed that construction of a long tubular gastric pouch reduces the risk of inflammatory complications, and renders it as safe as the RNY technique." While it has been CLAIMED that the change to a longer tubular Gastric pouch reduces the risk of inflammatory complications, there is little research that PROVES it. If you are interested in having this procedure done, keep this in mind. The entry for Gastric Bypass in WikiPedia can be found here: http://en.wikipedia.org/wiki/Gastric_bypass_surgery . Here is a short animation that shows what is done for the Mini Gastric Bypass: http://www.youtube.com/watch?v=OFQPLF9IjtI .

 The Duodenal Switch: (http://www.obesityhelp.com/content/wlsurgery.html#DS ) is the STRONGEST tool in this arsenal of weapons!  Many surgeons think it shouldn't be used lightly and often only recommend the procedure for people with a body mass index OVER 50!  In the Duodenal Switch, the surgeon REMOVES approximately 85% of the stomach including MOST of the region of the stomach that produces the hormone grehlin.  Grehlin is one of the hormones that create HUNGER.  Removing the section of the stomach that creates hunger is a HUGE feature of this procedure.  The surgeons then sew the rest of the stomach back together and create a tube shaped stomach that resists stretching.  The stomach varies in size depending on the surgeon and the patient but can be anywhere from 2 ounces to 6 ounces.  Perhaps more.  The next step of this procedure involves bypassing the intestine just like in the Gastric Bypass.  Instead of attaching the intestine to the SIDE of the stomach, it is attached to the BOTTOM of the stomach where the intestine used to exit.  The bypassed intestine is then sewn at one end near the liver and the far end of the intestine is sewn to the intestine that was attached to the stomach to pass bile to the intestines as it does in the gastric bypass.  This procedure is MOR