Liver Concerns Remain After Weight Loss Surgery

Nicole Cutler, L.Ac., MTCM, Dipl. Ac. (NCCAOM)®

May 3rd, 2013

Weight loss surgery might be beneficial for the liver of certain obese individuals, but it also poses some surprising liver specific dangers.

In addition to becoming increasingly common in our culture, obesity is also the number one risk factor for a majority of our nation’s predominant health woes. Contributing to the urgency for effective weight loss strategies, one of the problems compounded by obesity is fatty liver disease. Weight loss surgery is a medical procedure that is gaining popularity for obese individuals, especially if they have a fatty liver. Although weight loss surgery can help relieve liver inflammation and scarring related to obesity, it also harbors some unwanted liver implications. If you have already had or are considering weight loss surgery, make sure you know about the potential hazards posed to your liver’s health.

Obesity

Body Mass Index (BMI) is a calculation most commonly used to estimate obesity. BMI computations to determine obesity are measured by using an adult’s weight and height. For most individuals, BMI correlates with the amount of fat in their bodies. Obesity is generally accepted to be equivalent to a BMI of 30 or higher, while extreme obesity is considered to be a BMI of 40 and up. According to the National Institutes of Health:

More than 1 in 3 adults are considered to be obese.
More than 1 in 20 adults are considered to have extreme obesity.

There is no single cause of obesity and, likewise, there is no single approach to help prevent or treat it. Treatment may include a mix of behavioral treatment, diet, exercise and sometimes weight loss drugs. In some cases of extreme obesity, weight loss surgery may be an option.

Weight Loss Surgery

Weight loss surgery involves making structural changes to the stomach and/or small intestine. The two most common types of surgical procedures used to promote weight loss are:

Restrictive Surgery – By removing or closing a section of the stomach, this kind of procedure makes the stomach smaller – limiting the amount of food it can hold so a person feels full after eating less.
Malabsorptive Surgery – Shortening the length of the small intestine or changing where it connects to the stomach, this kind of procedure limits the amount of food that is completely digested or absorbed.

Through food intake restriction, malabsorption or a combination of the two, weight loss occurs because less food either enters the stomach or proceeds to the small intestine. In addition to rapid and dramatic weight loss, several types of obesity-related health conditions appear to improve following weight loss surgery such as:

Obese people with diabetes have improved blood sugar levels following weight loss surgery.
Obese people with non-alcoholic fatty liver disease have improved liver health, including a possible reversal of fibrosis, following weight loss surgery.

Weight Loss Surgery Liver Warnings

Knowing that weight loss surgery can help those with non-alcoholic fatty liver disease may serve as a substantial motivation for those affected. However, there are also many potential hazards to having this type of stomach or small intestine altering procedure. For the individuals who are actually candidates for weight loss surgery, the following side effects are common:

Gallstones – More than a third of obese patients develop gallstones after weight loss surgery.
Digestive Symptoms – Nausea, vomiting, bloating, diarrhea, excessive sweating and increased gas are common.
Nutritional Problems – Deficiencies such as anemia, osteoporosis and metabolic bone disease can develop.

Recent studies have highlighted two more liver specific weight loss surgery concerns:

Risk of Acetaminophen Poisoning – As discussed at a recent meeting of the American Association for the Study of Liver Diseases, a San Francisco study found that people who have had certain types of weight loss surgery may be at increased risk of acetaminophen poisoning and, in turn, liver failure. Researchers suspect that because obesity often causes liver damage, weight loss surgery patients may still have weakened livers that are more susceptible to harm from acetaminophen.
Risk of Alcoholism – As reported in the June 2012 edition of the Journal of the American Medical Association, researchers found that a year after weight loss surgery, the risk of becoming an alcoholic is significant. Researchers believe that certain types of weight loss surgery changes how the body digests and metabolizes alcohol, which can lead to an alcohol-use disorder. Drinking alcohol, especially excessive amounts, is a surefire route to liver damage.

Weight loss surgery carries a long list of possible risks, but it can be a lifesaver for certain individuals. For those with a BMI of 40 or more who have not been able to lose weight via other methods, weight loss surgery might be an option. If weight loss surgery is deemed the best choice, those undergoing this procedure must take extra care of their liver health – because the liver benefits of significant fat reduction will only be worthwhile if committed to caring for the liver by avoiding alcoholism and acetaminophen toxicity.

References

http://jama.jamanetwork.com/article.aspx?articleID=1185618, Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery, Wendy C. King, PhD, et al, Retrieved December 16, 2012, Journal of the American Medical Association, June 2012.

http://win.niddk.nih.gov/statistics/index.htm, Overweight and Obesity Statistics, Retrieved December 13, 2012, National Institute of Diabetes and Digestive and Kidney Diseases, 2012.

http://www.cbsnews.com/8301-504763_162-57455416-10391704/gastric-bypass-surgery-may-double-a-patients-risk-for-alcohol-problems/, Gastric bypass surgery may double a patient's risk for alcohol problems, Retrieved December 10, 2012, CBS Interactive, Inc, 2012.

http://www.ncbi.nlm.nih.gov/pubmed/17376042, Effects of bariatric surgery on nonalcoholic fatty liver disease: preliminary findings after 2 years, Furuya CK, Jr, et al, Retrieved December 12, 2012, Journal of Gastroenterology and Hepatology, April 2007.

http://www.sfgate.com/health/article/Bariatric-surgery-and-acetaminophen-risk-4091180.php. Bariatric surgery and acetaminophen risk, Erin Allday, Retrieved December 10, 2012, Hearst Communications, Inc., 2012.

http://www.webmd.com/diet/weight-loss-surgery/surgery-for-you, An Overview of Weight Loss Surgery, Retrieved December 13, 2012, WebMD, LLC, 2012.

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Nicole Cutler, L.Ac., MTCM, Dipl. Ac. (NCCAOM)®

Nicole Cutler, L.Ac., MTCM is a long time advocate of integrating perspectives on health. With a Bachelor's degree in Neuroscience from the University of Rochester and a Master's degree in Traditional Chinese Medicine from Five Branches Institute, Nicole has been a licensed acupuncturist since 2000. She has gathered acupuncture licenses in the states of California and New York, is a certified specialist with the National Acupuncture Detoxification Association, has earned diplomat status with the National Commission of Chinese and Oriental Medicine in Acupuncture and Chinese Herbology and is a member of the Society for Integrative Oncology. In addition to her acupuncture practice that focuses on stress and pain relief, digestion, immunity and oncology, Nicole contributes to the integration of healthcare by writing articles for professional massage therapists and people living with liver disease.