Gastric Bypass Surgery and PCOS
“PCOS is a complicated condition, which is usually only diagnosed when a patient presents with PCO and symptoms such as having fewer than six periods per year and/or excess body hair. We can also add to this diagnostic list one further tool: a blood test to measure hormone levels. So when a woman discovers that she has PCO, her doctor will need to examine her menstrual pattern, skin and hormone levels to confirm PCOS.
Many health experts believe that numerous variables, including genetics might be a factor in the development of PCOS. For example, you might find your sister, mother, aunt or grandmother has PCOS. It is clear that hormone imbalance is a primary influencing factor in PCOS as well as a condition called insulin resistance. Insulin is a potent hormone which is released by the pancreas as a result of food intake in particular carbs.Insulin conveys sugar out from the blood and moves it into other cells such as muscle, liver and even fat cells. The sugar is then changed into energy or in some cases stored as fat. Sometimes this process is defective which is called insulin resistance. When you have insulin resistance your pancreas has to produce excessive amounts of insulin to remove the sugar from the blood. These high levels of insulin are not good for the body and can produce a staggering array of symptoms.
Insulin resistance is very common in women with polycystic ovarian syndrome and can contribute strongly to the weight gain associated with this condition, sometimes to the point of obesity. Losing excess weight can make a huge positive impact on PCOS symptoms so this is sometimes the first recommendation a doctor will make in a management plan.
Gastric bypass surgery is the most widespread operation in the world directed at the struggle against excess weight. At present, about 200 000 gastric bypass surgeries are carried out each year, and this figure annually grows in the USA. The history of this operation totals about 50 years.
What are the signs of PCOS?
You might have noticed symptoms of polycystic ovary syndrome following the start of your first period or maybe health issues started later on in your twenties or thirties. These symptoms differ from woman to women but to be diagnosed with polycystic ovarian syndrome you need to have at least two of the following issues:
- Male pattern baldness
- Excessive hair growth
- Irregular periods
- Absent periods
- Ovarian cysts
- Heavy or prolonged periods
- Weight gain
- Menstrual pain
- Fluid retention
- Darkening of the skin
- Mood swings
- Acne not associated with puberty
It is important to get an early diagnosis because PCOS can lead to type 2 diabetes, infertility, heart disease, endometrial cancer, high blood pressure and breast cancer.
What is the best course of action to treat PCOS?
PCOS treatment is conducted by traditional methods and has the following goals:
- Normalization of menstrual and reproductive function;
- Weight normalization;
- Normalization of metabolic processes;
- Treatment of hyperplasia, endometrium and accompanying diseases of a mammary gland;
- Correction of dermatological manifestations of the raised maintenance of androgens – hirsuties.
The therapy of insulin resistance is indicated (especially at unsatisfactory results of the first stage of treatment). Metformin, which reduces the resistance of peripheral tissues in relation to insulin, normalizes glucose metabolism in fatty tissues, liver and muscles, and also makes a positive impact on the lipid profile of blood: reduces the concentration of atherogenous fractions lipoproteids. The duration of the preparation intake varies from 3 to 6 months.
At the achievement of positive results from the first and second stages of PCOS treatment (weight reduction and insulin resistance), the third stage – ovulation stimulation – starts. The stimulation of ovulation is fulfilled by means of clomiphene preparation. The preparation is indicated for the period of 5 days (from the 5th to the 9th day of the menstrual cycle). The dose of preparation gradually increases within 3-4 months.
Another method which is used at PCOS treatment is gastric bypass surgery which is used to treat obesity.
“PCOS is a complex endocrine disorder that is associated with, and aggravated by, obesity. Weight loss has been demonstrated to decrease insulin and androgen levels, as well as to improve the clinical manifestations of PCOS”.
The essence of this operation lies in the fact that the stomach is stitched by paper clips on two departments – the small, with the volume of about 50 ml, and the big stomach (the other part). The small intestine (the junction of a stomach and a gut is called gastroenteroanastomosis) is hemmed to a small stomach. As the volume of a small stomach makes only 50 ml, a person cannot eat much food after this operation and is fed up with a small amount of food. Besides, the food eaten by a person now passes through a new way, without getting to a big stomach and the most part of a small intestine. It means that not only the volume of the eaten food decreases, but the absorption of nutrients essentially decreases as well. Thus, the combination of these two factors – the decrease in the quantity of the eaten food and the reduction of the nutrients absorbed – leads to the fact that the patient loses up to 80 % of excess weight. This operation is “a golden standard” in obesity treatment, along with stomach bandaging.
Modern gastric bypass surgery is carried out laparoscopically, that is, without cutting the stomach. The gastric bypass combines two mechanisms of treatment of excess weight: decrease in absorption of nutrients and reduction of the stomach cavity. At present, there are a large number of options of such surgery; however, optimum, Roux-en-Y type is the most widespread.
What are some common side effects of gastric bypass surgery?
However, despite all the advantages of this surgery, there can be different complications. Gastric bypass surgery is accompanied by the risk of development of different complications. Some of them can be connected to diet.
- Vomiting: Vomiting can arise if to eat food very quickly and to use much liquid together with food, to eat food not in the form of mashed potatoes (badly chewed).
- Narrowing (stenosis) of gastro enteric mouth: Narrowing of artificially created channel can develop as a result of formation of commissures (the growth of connective tissue) or strictures (organic narrowing of any physiological opening or tubular body) between the new stomach and intestines. These problems can arise during the rehabilitation after surgery (later than in four weeks after operation).Symptoms of narrowing formation:
- vomiting after the food or liquid intake, being accompanied with health deterioration;
- feeling of food stuck in the throat;
- inability to use food that earlier caused no problems;
- inability to consume food otherwise than pureed.
- narrowing of mouth is treated with the help of endoscope, but treatment should be fulfilled immediately.
- Ulcer: After gastric bypass surgery, ulcer emergence is possible; often it is possible to cure it by means of certain medicines. It is necessary to avoid reception of non-steroid resolvents.
- Insufficiency of vitamins: Vitamins should be taken during the whole subsequent life. The emergence of heavy complications is possible because of a lack of vitamins and minerals.
- Functional disorders of intestines: Constipation is one of the problems after surgery. It can be connected directly with the undergone operation or with the reception of iron preparations. It is very important to prevent constipations as the pressure in the abdominal cavity rises at constipations, which leads to the risk of development of hernias, impassability of intestines, or hemorrhoids. During the first month following the surgery, it is very important to have a regular constipation and to use soft purgative medications. It is not necessary to accept purgatives regularly; it can lead to the formation of addiction to them. The simple methods to prevent constipation are:
- the use of apple juice without sugar or not very sweet plum puree in food;
- the sufficient use of liquid;
- daily physical exercises;
- four weeks after operation, it is allowed to use potatoes with peel, bread with cereals, crude vegetables, or beans.
- The problems with hair: The decrease in the quality of hair can occur if not to use a sufficient quantity of protein. The minimum quantity of protein for women is 50g per day. An insufficient intake of protein can lead to the damage of a hair root. Hair can break two months after surgery. However, it is not necessary to worry; at diet observance, hair will grow again. To prevent this complication, it is necessary:
- to consume a sufficient quantity of protein every day;
- to adhere to a dietary plan and if it is necessary to take additional protein to make the amount of the used protein corresponding to the norm;
- correct the diet if the amount of protein consumed is insufficient.
- Increase of a body weight: Gastric bypass surgery is only a tool for the actions in the fight against excess weight, complicated by PCOS. In order to achieve the desirable result, it is necessary to continue to work on one’s self. This method is not a panacea from obesity; it will lead to weight loss only in the long term if to observe certain rules. It is necessary to avoid the use of the food fried in fat or baked, use butter, margarine, and fried bacon. Greens, spices, wine, vinegar, mustard, or other seasonings, can be used in small amounts when cooking.
- Dumping syndrome: The dumping syndrome is a complex of symptoms of violation of hemodynamics and neurovegetative frustration in response to the fast receipt of gastric contents in a gut. The dumping syndrome can arise only after gastric bypass surgery. It is absent after bandaging of the stomach. The main reason for developing dumping syndrome is the lack of ability of the operated stomach to stretch in reply to the receipt of food. Therefore, after food intake, the abdominal pressure increases, its contents in significant amounts quickly arrive in a small intestine. It causes an inadequate irritation of the receptors and ionic violations. An extracellular liquid moves to a gleam of a gut, thus the right chemical balance is reached. In reply to the stretching of the gut walls, biologically active substances are secreted, and the content of glucose quickly accrues in blood. As a result, the blood vessels expand; the volume of circulating plasma of blood decreases; the motor activity of intestines increases. The emergence of such symptoms as weakness, dizziness, palpitation, perspiration, decrease in arterial pressure, pallor of skin, or pulse increase (sometimes pressure can rise) is possible. Strengthening of motor function skills can lead to the intestinal gripes and diarrhea, nausea and vomiting. Stomach spasms are also possible.The dumping syndrome can be provoked by the simultaneous use of food and liquid, the consumption of very sweet or fat foods, or the very rapid consumption of an abnormally large amount of food. Owing to the violations happening inside the small intestine, the number of vitamins digested from the food drops.
- Dryness of skin: Dryness of skin can be the result of body weight loss. The right diet can prevent the emergence of this complication.
- Pregnancy after gastric bypass surgery: In view of the fact that women at pregnancy require a greater amount of calories, it is recommended that women postpone pregnancy for 1-2 years, at first, to reduce and stabilize weight. This question should be discussed with the doctor.
What are some natural remedies for weight loss associated with PCOS?
PCOS natural treatment is conducted in several stages:
- The first stage in fighting with obesity includes reducing patient’s weight. A low-calorie diet (up to 2000 kcal a day) is indicated for a patient. Vegetative fats should make not less than one third of the total amount of fats. The consumption of salty and spicy products as well as water consumption has to be reduced.
- In parallel with a diet, daily moderate physical activities are also prescribed. Weight reduction favorably influences the patient’s general condition, reduces insulin resistance of tissues, and lowers arterial pressure. The mode of a diet and physical activities is chosen strictly individually.
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