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Rapid Weight Loss and Gallstone Formation

Posted Sep 26 2008 2:41pm


Over the course of my career as a dietitian, I have seen time and time again, the results of rapid weight loss. Today I will focus on just one of the many risks.

In 1990 I began to consult with Nutri-System. During my first week of learning all about their program, I was notified by Nutri-System’s corporate office that lawsuits have been filed against them pertaining to gallbladder disease. Apparently there is risk of gallstone formation when rapid or significant weight loss is achieved. This was a devastating event for Nutri-System. In conclusion, it is important that weight loss be achieved slowly with no more than a 10% loss achieved at one time. This has led me to focus on a healthy lifestyle as opposed to rapidly achieving weight loss.

I receive requests on a daily basis to assist my clients with “rapid weight loss” because of a function they need to attend and wish to fit into a size 2 dress. Thus begins the education on the risks involved with rapid and significant weight loss achieved in a short period of time. I can not stress enough how dangerous this is. If you develop gallstones, you must have surgery to have them removed. IMO, surgery should be avoided secondary to the problem of contracting a super-bug called MRSA. Just google MRSA and you will see what a problem this can be. On, a personal note, my brother developed MRSA from surgery on his finger and has been plagued with MRSA for the last several years. At this point, we are trying to avoid amputation of his finger.

You may wish to read the following abstract regarding gallstone formation:

Prevention of gallstone formation in morbidly obese patients undergoing rapid weight loss: Results of a randomized controlled pilot study

An increased risk of gallstone (GS) formation has been linked to obesity and to episodes of rapid and significant weight loss. Previous reports have suggested that bile salt therapy (ursodeoxycholic acid) or prostaglandin inhibition (ibuprofen) may prevent gallstone formation in this high-risk group. The purpose of this study was to investigate GS prevention following bariatric surgery. Design. Randomized double blind controlled trial. Methods. Sixty patients without gallstones preoperatively (gender, 9 male, 51 female; average preop wt, 349.6 lb; mean age, 38 years) were randomly assigned to receive urso (600 mg/day, n = 20), ibuprofen (600 mg/d, n = 20), or placebo (n = 20). At the time of standard open gastric bypass, intraoperative ultrasonography confirmed the absence of stones or microcalculi, and bile samples were collected via puncture of the gallbladder for bile lipid analysis. Following recovery and resumption of a bariatric diet, study medication was prescribed for the first 6 months postop. Gallbladder emptying and GS formation were assessed using ultrasonograms preop and at 3, 6, 9, and 12 months postop (gallbladder emptying following a high-fat liquid test meal was assessed preop, and at 3 and 6 months postop). Results. Forty-one (68.3%, 8 male, 33 female) of the original 60 patients completed all phases of the study (15 urso, 15 ibuprofen, 11 placebo). The average weight loss was 98.5 ± 7.2 lb over the 12-month period following bariatric surgery. Twenty-nine (71%) of 41 patients who completed the study developed GS. Of those who formed stones, 12 (41%) developed symptomatic GS and 8/12 (67%) underwent cholecystectomy (4 refused operation). Preoperative gallbladder emptying studies showed no differences in emptying between groups (urso 29%, ibuprofen 32%, and placebo 30%). There was no correlation found between the cholesterol saturation index (CSI mean 205.15, range 67-360) and the incidence of GS. There was a statistical difference (P < 0.01) between the ursodeoxycholic acid group and the ibuprofen group with respect to the incidence of stone formation. There was correlation between weight loss (mean 99 lb, range 21-278 lb) and GS formation, in that patients who lost more weight had a greater tendency to form gallstones. Complete medical compliance was achieved in only 17/60 (28%) of patients originally enrolled. Conclusions. This pilot study confirms the high incidence of gallstone formation (71% of assessed patients) associated with rapid weight loss in patients undergoing gastric bypass. Despite active enrollment in a supervised prevention trial, the two therapies investigated to reduce gallstone formation were not efficacious, likely because compliance with medical therapy was poor. These findings highlight the significant risk of gallstone formation in this patient cohort even when prevention strategies are utilized.

In conclusion: A slow gradual weight reduction is best.

If you have any questions, please don’t hesitate to send me a message.
http://www.TheMenuCoachChronicles.com
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