How Gut Problems Contribute to Bariatric Regain

How gut problems contribute to bariatric regain

Your gut health after bariatric surgery is dependent on bacterial balance. Tune in to learn how bariatric regain is connected to gut dysbiosis.

Check out this audio transcript!

Dawn: (00:01)
Hello, and welcome to the gastric health show. My name is Dawn Boxell and we are going to discuss a topic today on how gut problems contribute to bariatric regain. And I’m sure many of you have have the fear after bariatric surgery that will I be able to maintain this lifelong and why have I put on a few pounds? and so the regain is scary for many bariatric patients, and it’s also something that everyone is aware of, that we do know that it does occur in many of the bariatric patients after they’ve had surgery and it can be anywhere from 40 to 80% of you will experience some type of weight regain.

Dawn: (00:57)
Now not all of you will experience a complete regain of all that you lost. But some do and some just put on a few pounds and then, you know, I’ve, counseled lots of patients that really don’t put on, you know, 10, 15 pounds is really all they did from their lowest, which is pretty standard.

Dawn: (01:22)
So, but I get it. You’ve had weight loss surgery. You’ve had your anatomy altered and you want to be successful, you didn’t do this to not be successful with weight loss. So I get it. And I want you to understand that there are things you can do for yourself to help protect and prevent and help stabilize kind of where you’re at and what bariatric surgery provided you with your, your gut microbiome and continue to grow and improve that.

Weight loss after bariatric surgery

Dawn: (02:00)
So, that is kind of the focus of today. I want you to see that there are options, there are many things that you can do for yourself to contribute, to improving your ability to maintain weight loss after bariatric surgery. So let’s dig into one. I do want to kind of explain that there, there is several studies with the evidence on, and I’ll put it in the show notes that the regain is a real thing, and it’s a real concern that they they’re doing studies trying to help figure out what happens.

Dawn: (02:48)
Cause is it truly just a calorie problem? Is it truly just, you’re eating too much and not exercising enough? And really, I think most practitioners could agree that at least personally, I don’t believe that that is the only thing that’s happening. Do I think that people’s choices change and maybe life hits and, you know, they, they find themselves in a season of life that they just don’t have the time or that the bandwidth to to do some of the things for themselves that they used to.

Dawn: (03:27)
So yes, there are shifts in what they do but to me there’s more to it that drives it and that if you can put some of these things in place long term, it’s going to help one prevent it. But two, you know, reverse it. So if you can put these things in place and fix some of these areas long term, you won’t have the same issues.

How polyphenols impact gut bacteria & bariatric regain

Dawn: (03:58)
So, so here’s what we know about what influences gut bacteria already you know, having a balanced gut microbiome is key, but that comes with effort. That doesn’t just come with taking a probiotic pill and all your problems are solved. There are things that we have to do with making choices in our food that plays a role in if that probiotic is even going to be of value to you.

Dawn: (04:28)
So, just taking a probiotic and focusing on putting some good bacteria in is wonderful, but it’s not going to be the only thing that is going to correct it. And long term prevent regain. So here are things that we know that impact that bacteria. Polyphenols. We know. So these are things that are bright red, like beets and cherries and raspberries all of those real deep dark colors and bright reds are high in polyphenols green tea chocolates, really dark chocolates.

Dawn: (05:16)
All of those are polyphenols. So, you know, adding those in can help you because they can actually modulate gut microbes your microbial diversity. So the, the variety of different bacteria you have in, you want to have lots of different gut bacteria represented in your gut and it comes from what you’re putting in your diet and then it can also modulate the Firmicutes to Bacteroidetes ratio. And this is a direct correlation to weight.

Firmicutes ratio and gut bacteria & bariatric regain

Dawn: (05:54)
So when those are elevated Firmicutes or Bacteroidetes are elevated you are likely going to struggle with weight loss and be more weight loss resistance. So when those, those good bacteria Firmicutes and Bacteroidetes are still good bacteria when they are elevated and out of balance, then they can create an environment that your body will absorb more calories from the food you are consuming.

Dawn: (06:22)
So it makes it harder for you to to lose weight or to maintain the loss you’ve gotten, so you know, we know that the polyphenols are important for that, so if you don’t find yourself consuming those things, that could be a thing to take note of. Another thing is your nutritional state, so when you have vitamin deficiencies we do know that that alters different gut microbes. And we do know that adding in certain vitamins or minerals can increase certain gut microbes.

Vitamins impact gut bacteria & bariatric regain.

Dawn: (07:00)
For example, vitamin A is actually a great addition when it comes to your gut lining and it can do wonders with healing, a gut. And and this is more specifically like the retinoic acid, but it has the ability to increase certain species of gut bacteria. So lactobacillus and bifidobacterial that vitamin A, the actual pure form, the retinoic acid is what’s going to help improve your gut microbiome.

Dawn: (07:37)
So those vitamin a rich foods, of course, you know, liver is the top, but there are many, so vitamin A foods are even things that are bright orange, red, and yellow. But they have beta carotene that converts kind of at a low side. So not your best option, but there are, there are ways to get it in your food that will help you, so anytime you have those deficiencies, that’s going to impact your gut microbiome and then also certain carbohydrates because of the fibers and polyphenols and other compounds that are naturally in the foods that we eat. In the plants.

Dawn: (08:20)
The plants are your friends but they can increase a variety of different species in your gut and then certain fats. So I know ketogenic diets are super popular with some patients. And I think that’s where you have to be careful because some of it modulates it in a good way and some of it modulates it in a not as good way. So I think you have to, you have to pay attention and be individual. This is all going

Lifestyle factors that influences gut bacteria & bariatric regain.

Dawn: (08:54)
To be personal and what works for one won’t wont work for the other. So that’s where, you know, working with someone so that you can get some good benefits from making changes is key. And then of course, antibiotics and medications, stress, exercise. All of those can impact, your gut bacteria.

Dawn: (09:19)
So, you can see there’s a lot of factors and there’s a lot of things that can influence why someone’s gut bacteria might be out of balance and technically we call when your gut bacteria is out of balance, it’s considered dysbiosis and dysbiosis is just where you either have not enough good bacteria, too much bad bacteria or bacteria in the wrong location. And that would be like a SIBO, a small intestine bacterial overgrowth. So when you have dysbiosis something is contributing to that. So is it you know, things in your diet, is it stress?

Dawn: (10:07)
Is it medications? Did you take around it antibiotics? So that dysbiosis was created from something and that’s where it kind of shifts all the time. It, it, it is not something that changes and stays the same. It requires help from us and it requires us to be diligent, not perfect, but diligent on maintaining it.

What is dysbiosis ?

Dawn: (10:37)
So, I always like to think of adding you add in things, so if you’re gonna go out to fast food, maybe you choose a side that has some vegetables in as a side as opposed or fruit as opposed to the French fries. So, those are things that, you know, you have the ability to shift based on your choices. And there was a study in, let’s see here, the International Journal of food, sciences, and nutrition that was published in 2020.

Dawn: (11:14)
And I feel like they said at the best. It is the habitual diet that determines the long term resident and the gut. So if your diet is frequently high in sugars and alcohol and caffeine, and low in fiber. Guess, what your gut microbiome is not going to be in balance. And you will have dysbiosis. And you might be thinking well, okay, so I have dysbiosis, I have a few symptoms who really cares. But let me explain dysbiosis is kind of a common thing that is seen before surgery.

Dawn: (11:55)
So they’ve done lots of studies on bariatric patients and before surgery and just obesity in general. We know that obese individuals have dysbiosis. They have an imbalance in their gut bacteria. So it’s either, and it’s probably a combination of all of ’em it’s you know, they don’t have enough good bacteria, they have too much bad bacteria and bacteria in the wrong location.

How dysbiosis causes bariatric regain ?

Dawn: (12:23)
It’s very common for obese individuals to have SIBO and to have this dysbiosis, so going into surgery all of you have dysbiosis. So what do we know about what happens after surgery? that’s where kind of the cool stuff happens and they know that the dysbiosis shifts. So we know that the Firmicutes to Bacteroides ratio, so whenever you have Firmicute’s or Bacteroide’s elevated, that’s bad. So these are good commensals, but yet they need in balance.

Dawn: (13:00)
Even though they’re good, doesn’t mean more is better. And when they’re elevated there’s a direct correlation with poor health and obesity. And just a.. Increase in weight. Because what happens is those bacteria have the ability to increase the calories that you are absorbing. So you will absorb more calories when you have an elevation in your Firmicutes to Bacteroidetes. So that’s how it contributes to your weight regain.

Dawn: (13:33)
So if you have dysbiosis after bariatric surgery, then guess what you likely will struggle with weight loss can be more weight loss resistant, and maybe just really easily put on the pounds with you don’t feel like. Hey, I’m really not changing too much of my diet, so why am I seeing so many pounds go up on the scale? So, that you know, dysbiosis is a big deal. It is something that can contribute to long term problems with weight.

Bariatric surgery partially rescues dysbiosis

Dawn: (14:15)
So, what else do we know about bariatric surgery? and there are additional studies what we know, and this is in multiple studies, I have seen this, that this one was in an obesity report in 2019 and that they know that bariatric surgery only partially rescues the dysbiosis from pre-surgery. So we know that all obese individuals have dysbiosis and then bariatric surgery happens.

Dawn: (14:49)
It flips it, but it doesn’t flip at all. It doesn’t completely solve or resolve the dysbiosis. And they realize that this impacts metabolic improvements and weight loss. So they know this is part of it and the question is this part of why people struggle months and years out is because it didn’t fully rescue the dysbiosis. It didn’t fix it all. It only partially did it. So that’s where it goes into your court.

Dawn: (15:25)
That’s where it’s on you, where your choices matter, where if you don’t maintain what bariatric surgery created, the, the benefits of solving a lot of the dysbiosis, but if you don’t maintain that and then continue to improve on that with these types of, you know, avoiding antibiotics as much as possible, and, you know, avoiding the medications that can make it worse and, you know, making sure you’re, you’re eating plenty of the carbohydrates that are rich in fibers.

2020 Study late regain after gastric bypass

Dawn: (16:02)
and then getting those polyphenols and make sure your nutritional status is on point in, you’re not deficient. Because that’s going to impact your long term success because it doesn’t fix it permanently it’s, this is where it’s in your court and you need to continue to make those improvements, so there’s also some other studies in the Journal of Obesity Surgery in 2020 they found that the gut microbiota individuals.. of individuals, which presented late weight gain after a Roux-en-Y gastric bypass was significantly different in comparison to individuals with successful weight loss.

Dawn: (16:45)
So, when that gut microbiome is unbalanced or dysbiosis, then or even diversity. It just, doesn’t, it lacks diversity, which translates in you lack fiber or lack polyphenols, both of those. So if you’re lacking in those then guess what, you’re probably going to experience weight gain even.. It could even be 10 years later.

2019 study gut bacteria & weight loss after gastric bypass

Dawn: (17:15)
I don’t remember specifically on this study how many years it was when they consider late. But the, the links will be in the study that you can, you can look through that if you desire. Another study in the Journal of Obesity surgery in 2019 the role of gut microbiota is in sustained weight loss following Roux-en-Y gastric bypass surgery and the results indicate that the gut microbiota are at least functionally. If not compositionally different between the poor weight loss and the successful weight loss patients.

Dawn: (17:54)
So we know that the gut microbiome is playing a role in your success with weight loss. So again, it goes back to that dysbiosis and that diversity in making sure that you have not perfection, but diligence in making sure all these things are in, you know, included in your routine and then another.

Dawn: (18:36)
Let’s see here, Journal American journal translational research 2019 gut microbiota specific signatures are related to the successful rate of bariatric surgery. Successful patients have presented a more diverse core microbiome, what could represent a dysbiosis status of the other groups? So what they’re saying is that the people who were considered successful that lost the weight and maintained it, their microbiome was healthy and in balance compared to the other group who regained weight and they had dysbiosis. So this is where it all comes down to really just two things, the dysbiosis and diversity.

Dysbiosis after bariatric surgery

Dawn: (19:17)
You really got to fix the dysbiosis. So you got a increase. If you have too little good bacteria, you’ve got to fix that. If you have too much bad bacteria, you have to fix that. And if you have bacteria in the wrong location, again, fixing that with SIBO. So, and how do you do that? There, you know, there are things you can do. There’s a SIBO breath test. Your doctor can order.

Dawn: (19:45)
I can also do that for you as well. We can Do SIBO breath test. We can do stool tests. All of those can give us information of what’s driving it. So if you wanna know, is my Firmicutes and Bacteroidetes ratio elevated. And that’s probably why I’m gaining weight and I’m not changing my food. A stool test will give you that information.

How we can help you ?

Dawn: (20:09)
I can get that from our GI map stool test, and it’s easy. That’s just a one day collection and it is great feedback and it’s personal to you. It can identify parasites, it can identify opportunistic bacteria. If there’s an overgrowth of too much of the bad stuff, it can tell us , you don’t have enough of the good stuff , it can tell us you have H. pylori many things and then diversity, if you are lacking fiber in your diet, you will be lacking diversity.

Dawn: (20:44)
and I will say, I feel like that is something that a lot of bariatric patients struggle with because of their volume, they struggle with getting enough volume of food in Cause you get full so fast and so when that happens, you have to get creative and that’s where I work with you and can help you strategize and using as much, whole real food as possible and then we utilize specific probiotics.

Conclusion

Dawn: (21:11)
It can really, combining those two together can really change that whole environment. We can, we can recondition and rebuild your whole gut microbiome. So you no longer have dysbiosis. You can have a healthy gut and you can maintain a healthy weight and lose it. You can lose regain by focusing on your gut health and that’s what I do. My programs are all about focusing on improving your gut microbiome improving your inflammation and really just focusing on stabilizing blood sugar.

Dawn: (21:54)
So those three main things are the focus to help get you the results that you desire with bariatric surgery. So, if that is you, if you feel like. Hey, I’ve had regain and one I don’t feel like, I’ve changed a whole lot and I’m experiencing this then. I would definitely consider doing some of my programs, working with me on some of these strategies. So, that you can reverse all of any of the dysbiosis that you have. We can definitely help you re-lose any weight that you’ve gained, because that is just part of doing the protocols.

Dawn: (22:42)
It really does help free up your body and make it work just like it should. So, I hope that helps you guys and it gives you something new to think about with your gut microbiome. Dysbiosis and just correlating it with regain, and how this impacts your success long term. So, you guys have a great day. See you soon . Bye.
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