WLS Gut Health Basics: Helping You Achieve Better Health

The Health of Your Gut Helps Determine Everything from Weight Loss to Your Overall Physical and Mental Well-Being

Weight loss surgery is a fabulous tool proven to successfully treat obesity and several associated diseases including cardiovascular disease, diabetes, and sleep apnea. However, for many it comes with significant side effects including abdominal pain, acne, anxiety, constipation, fatigue, headaches, chronic heartburn, weight regain, and unfortunately severe bouts of depression.

These symptoms are common complaints that not only interfere with quality of life, but if left untreated can progress to more complicated problems. The key to solving these issues for many starts and stops with the health of your GUT.

That’s right, more and more scientists, doctors and researchers are discovering the incredible link between your GUT HEALTH and your physical and mental well-being.

In fact, research is just now proving your GUT HEALTH plays a central role in determining how much weight you will lose after surgery and how long you maintain your weight loss.

What is gut health all about

When you hear the term Gut Health, first we are referring to all the physical organs that make up the digestive system (your mouth, spleen, stomach, liver, gall bladder, pancreas, small intestine and colon) and how these organs work together to influence and control the rest of your body.

Second, living inside your gut are an estimated 1,000+ diverse bacterial species commonly called your gut flora. These bacteria comprise a large portion of your Microbiome (all the bacteria living in and on your body).

Your digestive system does more than break down food

This diverse set of organs is highly connected with the rest of your body providing a Super Highway of Communication (i.e. vitamin B12 absorbed by the digestive system plays a critical role in transmitting nerve impulses by helping create the protective myelin sheath around each nerve cell).

And, did you know your digestive system….

Houses over 70% your body’s immune cells
Is often referred to as your SECOND BRAIN, due to the dense amount of neural tissue found throughout it’s structures
Is largely responsible for your overall mood as over 95% of your serotonin (the “feel good” or “happy” hormone) is produced in your digestive system, traveling on a superhighway to the brain via the Vagus nerve.

Plus, as previously mentioned it is home to over 1,000 different species of bacteria, commonly referred to as your gut flora. Your gut bacteria not only influence when and if certain “genes” within your DNA are expressed, but how and what your digestive system communicates with the rest of your body.

Introducing the 3 -4 pounds of bacteria you cannot live without

Scientists have only recently begun to understand the importance of your mircobiome and it’s overall role in health and disease.

As an example, Research has proven that infants born by c-section, not breast-fed, or borne by mothers with less diverse gut flora are themselves at a high risk for being born with poor gut flora and consequently are more prone to suffer from chronic diseases like diabetes, autism, and YES OBESITY!

The good news is these bacteria are extremely resilient and after years or even decades of abuse. You can reverse this trend and even start to make a positive impact on your microbiome.

The lifestyle choices with the biggest negative impact you should look to avoid and eliminate if at all possible are:

Antibiotics, birth control pills, NSAIDs
Chronic stress
Chronic inflammation
Chronic disease
Diets high in packaged, processed foods
Diets high in refined carbohydrates, artificial sweeteners, & sugar yet low in fiber
Environmental toxins
Alcoholism

While research involving your Microbiome is still relatively brand new, one thing is for certain. The 3-4 pounds of bacteria living in your gut is definitely weight you DO NOT want to lose.

Weight loss surgery has both a positive and negative impact on your gut health

Weight loss surgery is designed to remove, or staple off most of the stomach tissue. The obvious benefit being it provides fullness on a small amount of food. However, as doctors and researchers are now discovering, this is only half the story behind all the weight loss.

The other half of why the surgery is so successful at treating obesity involves your gut bacteria. Turns out, these bacteria play a major role in determining how many calories your body absorbs from the foods you eat. The surgery has been shown to increase the “Good” bacteria while decreasing the “Bad” ones.

For more on the specific impact Gastric Bypass and Gastric Sleeve Surgeries have on your gut health, see images below

Digestive enzymes and stomach acid linked together

Less stomach tissue means low stomach acid (hypochlorhydria) or no stomach acid (achlorhydria). As studies show, gastric acid secretion from the gastric pouch is negligible after gastric bypass (read more here).

Anyone with a history of GERD, reflux, and heartburn would think, how awesome, less stomach acid, problem solved. Unfortunately, Not True! Stomach acid and enzymes work together and both are necessary for you to digest food.

Naturally, digestive enzymes are secreted in the mouth, stomach, & intestines to help break down food into absorb-able particles, but it is stomach acid that actually turns the enzymes “ON”.

Without stomach acid, the digestive enzymes remain dormant and inactive making it difficult for your body to digest protein, fat and carbohydrates. To complicate it more, many WLS patients are prescribed heartburn medications (PPIs-proton pump inhibitors) for years or even decades either before or after surgery. These medications effectively shut off ALL stomach acid.

If the stomach doesn’t have an acidic environment, digestive enzymes are not activated and the imbalance in the stomach and intestines begins. Once properly diagnosed (which unfortunately is rare among many weight loss surgeons) it can take months to restore.

No stomach acid equals big problems

Low stomach acid puts you at risk for stomach & intestinal infections (H. Pylori, C. Diff, SIBO, etc.), as acid is needed to kill the bad bugs we consume accidentally. Your stomach is designed to stay at a pH of 1-3. Most bacteria can’t survive 15 minutes in a pH of 3. When stomach acid is low and the pH of the stomach rises above 5, bacteria begin to thrive (read more here).

In gastric bypass surgery the gastric pH levels rise to 5.7-6.8, and is predicted that the intestines of those individuals should be more likely to experience microbial overgrowth (check out this article). This can also be seen in any individuals that use PPIs where delayed gastric emptying is associated with reduced acidity (read about that here).By lowering stomach acid and increasing stomach pH, acid suppressing drugs increased the risk of H.Pylori infection and subsequent development of duodenal or gastric ulcers.

When stomach acid is low and the stomach pH is too high, as you learned the enzyme that digests meats and protein foods (pepsin) isn’t released making it very difficult for WLS patients to tolerate heavy protein foods. WLS patients commonly attribute this aversion to the taste changes they experience, but the reality is low stomach acid may be the culprit.

Lastly, low stomach acid doesn’t allow the vitamins & minerals (Vitamin B12, folate, iron, calcium, magnesium, zinc, etc) in food & supplements to be broken down and absorbed, therefore leading to deficiencies in these essential vitamins & minerals. Then as the food stagnates and passes through undigested it impacts your intestines and gut bacteria by creating an environment for bad bacteria to flourish.

Gut bacteria are positively impacted immediately after weight loss surgery

There are many factors that impact gut health after weight loss surgery and one of major concern for obese individuals is the fact they have less diverse gut bacteria.

This means every WLS patient goes into surgery with more of the bad guys (Firmicutes-which extract more fat/calories from food) (read about that here) and fewer of the good guys (Bacteroidetes-more prevalent in lean people), (learn more here)

The good news is recent research shows the surgery powerfully changes this dynamic. Where soon after surgery, the gut bacteria shifts to that of a lean individual with a more diverse environment and a higher prevalence of bacteroidetes to firmicutes ( read here).

Unfortunately, bacteroidetes and firmicutes are easily influenced by food, stress, medication, activity and environment. Therefore, supporting gut bacteria with probiotic rich foods (check out our recipes), supplements (designed specifically for WLS) and a gut healthy lifestyle are the best ways to protect this microbial balance.