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Gout Dugout.Issue #076 | Just how good is bariatric surgery for gout ?
December 31, 2016
Hello and Welcome to the Winter (December) 2016, edition of the Gout Dugout newsletter. The Gout Dugout is the 10 minutes' read from www.best-gout-remedies.com that gives you useful ideas that may help you with your gout. Copy and print if you prefer to read a version on paper. If you are extra busy now you could bookmark it for later.
A merry Christmas to all readers from best-gout-remedies.com
Most of this issue explains a recently published Swedish study,(1) which included results about Bariatric Surgery for gout prevention. Bariatric surgery for gout is worth knowing about, but there will be readers who are unfamiliar with even the name. So what is it ?
BARIATRIC SURGERY FOR GOUT
Bariatric surgery (BS) is hospital surgery for weight loss. A bariatric operation can eventually reduce weight, generally by up to 80% of someone's excess weight.
It interests people who simply cannot lose weight by diet and exercise, slimming pills, anti obesity drugs and so on. The study's gout and uric acid experiments were actually part of a larger study which looked at bariatric surgery (BS) for a range of medical problems such as diabetes, heart disease, blood pressure and other afflictions, which included elevated uric acid and gout.
But I'll focus on the gout inquiries.
Obesity and gout So have you wondered if BS can help you ? Especially if your gout is worsening, as it almost invariably does if you fail to control it.
Bariatric surgery can be the last resort for some gouty folk who simply cannot lose weight and lower their uric acid. And because it’s a last resort for their obesity and gout problem, it is good to know that there are studies that show bariatric surgery has a high success rate in treating gout Let's have a look at this Swedish obesity study learnt about gout.
BARIATRIC SURGERY LOWERS BOTH THE RISK OF GOUT AND URIC ACID
Being obese is a definitely a risk factor for gout. It’s defined as a BMI – Body Mass Index – of 40 or above (or 35 - 40 in those with significant medical problems caused by or made worse by their weight). If you have a BMI of 40, you are about 100 pounds above your ideal weight. That is a lot to lose. After BS you could eventually lose around up to 80% of that i.e. around 80 lbs (5 stones 10lbs), about a year after the operation.
"Lose that extra weight to lower your uric acid," is standard advice throughout the world of gout, and that advice is right with none of the equivocation that characterises (characeterizes) so much gout treatment advice, and which confuses people.
Only a too-low-percentage of persons who attempt diet to lose weight, actually succeed. So BS becomes something for many gout patients to consider. But will it work ? Gout medications and natural remedies do not have a 100% success rate. Neither does bariatric surgery. This Swedish obesity study concluded it does indeed have much success among obese people in preventing gout and lowering uric acid.
The study, which lasted many years, set out to learn whether BS had a better effect on subsequent gout and higher uric acid compared to conventional gout treatment among obese people.
Bariatric surgery operations Here is a simple description of the three BS operations in the study. (There are others). They have somewhat obscure names like gastric bypass, gastric sleeve and gastric banding.
Gastric by-pass and gastric sleeve include stomach stapling procedures (aka vertical banded gastroplasty). This reduces the size of the used stomach. At the same time, your appetite falls.
Stomach stapling is an intrinsic part of some Bariatric Surgery operations.Here's simple picture of what it is.
In gastric banding (aka lap band) - an inflatable belt (band) is positioned around the top part of the stomach. This also reduces its size and thus the amount of food it holds. So you eat less food and fewer calories and lose weight. In gastric by-pass, the second procedure in it, is that part of the intestines and the lower stomach are also by-passed, so the remaining intestines absorb fewer calories. The gastric sleeve operation just staples the stomach.
After these surgeries, a person can only eat 3/4 to 1 cup of food for a meal, but will still feel full.
Gastric band on the top part of the stomach. Note the gadget to inflate/deflate it.
How successful was bariatric surgery for gout in the Swedish study ?
Just about half the experiment’s participants underwent bariatric surgery operations. At the beginning none of the trialists (both those undertaking surgery and those who were not), had gout. The key question - were those on whom BS was performed less likely to get gout during subsequent time than those who had not ?
So 1,982 patients who underwent bariatric surgery were compared with 1,999 matched obese participants who did not have surgery but practiced gout treatment such as diet and exercise, or even had no treatment at all. As mentioned, at the outset none had gout. But what happened as time went by? Over around 19 years of monitoring trialist-patients, it turned out that those who had bariatric surgery were 40% less likely to develop gout than the others.
More results were that the others - the controls, who did not have surgery – went through 201 "gout events" (probably flares) but those who had BS had fewer – 138 "gout events."
What about uric acid levels? The BS group were 53% less likely to have high uric acid – hyperuricaemia (hyperuricemia) which is a serum (blood) uric acid amount of 6.8 mg/dL and above.
Over time, 314 patients from the non surgery group developed hyperuricaemia but fewer, 188, from the surgery group developed it.
In the surgery group, after 2 years, the BMI (weight) had fallen 23%, but in the non surgery group there was no change. Post operation, and after 10 years, BMI had fallen 17% but in the non surgery group it went up 2%.
Did the type of bariatric surgery in this study affect the result? No. It didn’t matter which of the three sorts in this trial a patient had undergone.
OTHER BARIATRIC SURGERY FOR GOUT STUDIES
In one study there was lost weight and reduced uric acid after three months. (2).
In another study among obese people who had diabetes (3), serum (blood) uric acid initially rose after the surgery. But after one year it had fallen 2.35 mg/dL (0.14 mmol/L) in tandem with weight loss. A drop of 2.35 mg/dL is quite a good reduction but not brilliant. And it was in people with diabetes which might confound the result because uric acid could fall more in that group. Diabetes in itself has a uric acid lowering effect.
Among those in this study who also had gout, just 12 people, 83% had hyperuricemia (high uric acid) at the outset, but that fell to 33% one year later. A 55 lbs (almost 4 stones) average reduction in weight meant a 1.3 mg/dL fall in blood uric acid.
In a third study, bariatric surgery also led to lower uric acid.(4)
Comment You might well get a 2.35 mg/dL drop in serum uric acid (and often more) from uric acid lowering medications like allopurinol, febuxostat, probenecid, and benzbromarone. With krystexxa, (if you can take it), probably a much bigger reduction. You probably would not achieve that with natural remedies, (except possibly by standard dieting), which seldom lower it by more than 1.0 mg/dL.
BARIATRIC SURGERY FOR GOUT - IS IT WORTH TRYING ?
So is it worth it? Only you, your doctor and other advisers can decide that. It requires much serious thought. In common with all gout treatments bariatric surgery is not totally successful. In one of the studies above, and despite the operation, many developed gout, suffered "gout events" and didn't lower uric acid.
Here are some pointers.
BS is really only for the obese. Is your weight similar to the trial participants? The Body Mass Index (BMI) of the control group (none BS surgery) was 40 +/- 5; of the surgery group, 42 +/-4. Obesity begins with a BMI of 40.
To calculate your BMI from pounds and inches: Dec 2016 GD to BMI calculator There is a link on this page to do it from metric measurements, if you wish If you were successful and lost 70% of your excess weight, how much would you now weigh ? If your excess weight isn't much, the operation really isn't worth it. Some other factors to consider Are your meds working? If they are, why go to the trouble and possibly expense of bariatric surgery ?
Remember that in this obesity study, (and at least one other), quite a few months passed before uric acid eventually fell. As you can see from the other studies. So you may have to wait months before it is clear uric acid has fallen. You will have to be patient.
For bariatric surgery risks – see below in Links
Before you decide you may want to re-examine how you are dieting, to see if mistakes are being made. And whether you exercise sufficiently. Additionally you might lose as much as 70 lbs, but find your blood uric acid level only falls by 1 or 2 mg/dL and you still have hyperuricemia. How much do you have to lose to get it below 6 mg/dL?
But you may have other reasons to do this surgery as well as for gout control and uric acid reduction. e. g. high blood pressure, diabetes and others. That could tip the balance in favour of a BS operation.
BARIATRIC SURGERY - LINKS
I won’t go into all the details of the types of bariatric surgery so please look them up. You'd probably get most weight loss from gastric by-pass, but to take it further you need to research the types of BS operations.
You'll find BS videos on YouTube.
Those who have done bariatric surgery describe their experience.
About one in five gout sufferers has kidney stones. Get rid of them naturally if you can. Click on the banner ad
PUBLISHING DATES OF THE GOUT DUGOUT IN 2017
2017 is just around the next bend. So here’s a short reminder about the Gout Dugout publishing dates next year. Look out for the Gout Dugout in your inbox towards the end of - March (spring), June (summer), September (autumn/fall) and December (winter).
Use www.best-gout-remedies.com's search box, located towards the bottom of the Home Page, to find site references to any word you enter into it. It is a good way to find out where and what the site has to say about any gout topic. For example, want to know more about Rasburicase for gout? Type Rasburicase in the search box.
There are currently around 260 pages, including all the back issues of this newsletter. It works. Use it!
Thanks for reading.
Wishing you a happy New Year, and the best of gout free health in 2017.
John Mepham BA (Econ) Makati City Philippines
(1) Cristina Maglio, Markku Peltonen, Martin Neovius, Peter Jacobson, Lennart Jacobsson, Anna Rudin, Lena M S Carlsson.: Effects of bariatric surgery on gout incidence in the Swedish Obese Subjects study: a non-randomised, prospective, controlled intervention trial. Ann Rheum Dis annrheumdis-2016-209958 Published Online First: 8 October 2016 doi:10.1136/annrheumdis-2016-209958
(2) Nanji AA, Freeman JB. Rate of weight loss after vertical banded gastroplasty in morbid obesity: relationship to serum lipids and uric acid. Int Surg 1985;70:323–5.
(3) Dalbeth N, Chen P, White M, et al. Impact of bariatric surgery on serum urate targets in people with morbid obesity and diabetes: a prospective longitudinal study. Ann Rheum Dis 2014;73:797–802.
(4) Dalbeth N, Pool B, Yip S, et al. Abstract. Effect of bariatric surgery on the inflammatory response to monosodium urate crystals: a prospective study. Ann Rheum Dis 2013;72:1583–4.
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