Bariatric Surgery: Death Rates and Cause of Death within 5 Years Post OP

(aka Nick) #1

The first rule of extended fasting is that you should never tell anybody that you’re fasting. They will think you’re crazy. You’ll probably also hear things like, “That can’t be good for you”, or “isn’t that dangerous?”.

I don’t think that fasting is risk free, and I think it should be approached with thoughtfulness, caution, and careful adherence to best practices, but I don’t think it’s particularly dangerous compared to the alternatives if you’re morbidly obese like I was (BMI >40).

I consulted with a bariatrician who avised me that extended fasting was extremely dangerous and recommended that I stop keto immediately and work with their nutritionist to learn how to implement the DASH diet (High Carb Ultra Low Fat). I asked what her success rate with the diet was, and what percentage were able to reduce their weight and avoid bariatric surgery. She couldn’t tell me. I asked if it was even 5%. She couldn’t answer that question. I told her that if the best she could offer was recommending a diet with a 95% failure rate, that would lead to a $25,000 surgery, I needed some time to think over my options. I’m glad I did.

Here is an interesting study on the “safe” route (bariatric surgery) recommended by the solemn folks in white coats. This study covers the death rate of patients of bariatric surgery in the 5 years of post-op
and catalogues the causes of death for the state of Pennsylvania from 1995-2004. It’s startling.

Loads to unpack here, but I’ve got a busy day and not much time. Here are two charts that should raise some eyebrows. The 30 day death rate is around 1% which is horrifying. Don’t worry though kids, when you die of gastrointestinal bleeding within 30 days of a bariatric surgery, that’s “natural causes”. That tells you everything you need to know about how objective the report is, but the data is so truly shocking, even with a whitewash it’s pretty grim. When you consider that there were 16,683 surgeries, and the dollar value of that with surgery cost and post care is conservatively $50,000 per patient, you realize that they made $834,150,000 in the process. That’s just Pennsylvania, and the rate of bariatric surgery is growing exponentially.

When I first got into fasting, I read the medical literature regarding the death rate and complications for patients undergoing medically supervised fasting. It was actually a pretty common mode of treatment from from 1960-1980. I found about 20 something deaths in total. That’s about when bariatric surgery started to grow exponentially.

It makes me wonder, was fasting abandoned in the treatment of morbid obesity because it was dangerous, or because bariatric surgery takes 2 hours, pays $25,000 and creates a lifetime income stream from post-op care and complications. There’s about a billion dollars in PA that suggest the latter.

It’s something to think about the next time you see someone in a white coat solemnly warn against the “dangers” of extended fasting. Read the study!

(Bacon is the new bacon) #2

You might get better advice from a bariatrician who is a member of the Obesity Medicine Association (formerly known, if I recall correctly, as the Bariatric Surgery Association), because they heavily promote a ketogenic diet first, and surgery as a last resort. Dr. Eric Westman is a past president of this society, so that should tell you something. The OMA’s Web site has some very useful information on it.

(aka Nick) #3

Wow. I knew that bariatric surgery rates were growing, but not by how much. There were 1,343,000 bariatric surgeries in the US from 2011 to 2017. At $50,000 a pop for surgery and post op care, that means bariatricians and their helpers made $67,150,000,000. Realistically, the dollar value is probably 3 times that with all the years worth of complications that bariatric surgery entails.

Let’s pretend the 2 year fatality rate was only 2.5%. That’s 33,575 deaths. On the bright side, it’s a respectable $2,000,000 per death. Wow.

(aka Nick) #4

I’d be too nervous to go back to a bariatrician, regardless of their affiliation. The death rate for bariatric surgery patients is 6 times higher than the death rate for active duty soldiers in war zones, which during the height of the Iraq war was 335/100,000 for soldiers vs 2,100/100,000 for bariatric surgery patients!

I’ve got good insurance, and I’m worth $50,000 dead or alive. I’ll stick to fasting… :yum:

(Bacon is the new bacon) #5

Sounds like a good idea! :+1:

BTW, those 20 fasting deaths in 20 years that you mentioned in your OP—they were out of how large a group of fasters?

(aka Nick) #6

I wish I knew. The study didn’t say. I don’t know if anybody kept stats on that but I’d love to find them. The fascinating thing is that the #1 killer wasn’t water fasting, it was liquid protein diets meant to “safely” mimic fasting. Here is the paper:

(bulkbiker) #7

A while ago I found the dietary advice for pre bariatric surgery patients at a London (uk) hospital… They were suggesting a very low cal liquid diet because… wait for it!
They wanted to get their patients into ketosis to shrink the liver pre-surgery…
If they had carried on with that then they may have been able to avoid the surgery altogether…
It seems to have unfortunately disappeared from that particular organisations website but it is probably what sparked off the Newcastle Diet trials which also measured for ketosis.


The pre-surgery weight losses on My 600-lb Life was one of the things that made me turn to keto instead of considering surgery. Again. I had my stomach stapled in 2000. A big disappointment.

For example, on an episode the other night, Dr. Now had a 718 pound man. The doctor gave him a diet (“1200 calories” and “high protein, low carb”) and told the patient he was expected to lose 120 pounds in two months. The patient actually dropped 141 pounds.

The patient ended up losing over 250 pounds before surgery.

On another recent episode, a patient started at 728 pounds. She was told she should lose more than 120 pounds in one month on the diet. “It takes a lot of calories to maintain that weight.” Unfortunately, that patient died of heart failure several months after the surgery. She had gotten to under 400 pounds. But she started with congestive heart failure and the doctor stressed throughout that she was a time bomb living on borrowed time.

(Ilana Rose) #9

Can you point me to the report where this is mentioned?

(aka Nick) #10

I forgot to link the study in the original post. :smirk: I’ve edited the OP to include it, but here it is in case anyone wants to read it

(Karen) #11

I have a friend that recently underwent this operation. She’s lost 60 pounds. She was definitely obese. She’s over 40 years of age. But her weight loss appears to be successful. I suppose it’s because you can’t eat much. Not sure. Now I am worrying about her.

(aka Nick) #12

Sorry I didn’t link the study before! I was in a bit of rush. The table is linked below…

I’m not sure I’d characterize “therapeutic complications” within 30 days of a major surgery as a natural cause of death. Nor GI tract bleeding after GI surgery. If you die of sepsis after someone cuts you open with a knife, and fools around with you guts, I think it’s also reasonable to suspect that there may be a link!

There is no question that this is a highly at risk population, so it’s not reasonable to attribute all of these deaths to the surgery itself. It is unreasonable to not determine how much more at risk people are post bariatric surgery than a comparable control group. All of these statistics should be compared to a cohort of patients for whom the surgery was recommended, but elected not to have it done. Give the billions of dollars involved and tens of thousands of deaths, I think that might be prudent. If people die of pulmonary embolism after bariatric surgery at 5 times the rate of the control group, well that’s probably something that should be disclosed to patients and their primary care physicians. Hopefully this research has been performed. I haven’t had time to go looking for it yet.

The study also had a lot of exclusions. Some were appropriate (car crash), some less appropriate (suicide). They did note that the rate of suicide was just a tad high. The average rate of suicide for PA is 7 per 100,000. In the bariatric surgery cohort, deaths from suicide/drug overdose rose to 177 per 100,000. One way of putting that is that these folks are 2500% more at risk for suicide than average. I reckon that’s something patients and their families should know, but I didn’t notice it when I was reading brochures in the waiting room of my bariatrician…:yum:

(Ilana Rose) #13

I agree that it’s a stupid wording but I don’t think that they were trying to be dodgy. i think they were just using a “standard” medical distinction between “natural” as in from some medical reason and “unnatural” as from something traumatic, self imposed, or homicide. So car crashes, falls, drug overdoes, suicides, murders…that sort of thing.

I completely agree. patients need to be made aware of the risks for a voluntary surgery like this.

Wow, that’s just insane. But when you think about it, it makes sense. The bariatric surgery has an enormous impact on a huge part of these people lives and takes it completely out of their control.

Thanks for that link and your thoughts on the suicides. I had started skimming before I got to that point so I might have missed it myself.

(aka Nick) #14

Fair point. I’m probably over-reacting a bit. I guess I’m probably over sensitive on the issue. People who know that I fast often treat me like I’m missing a few screws. People have told me that they think it’s dangerous. They could be right, but I think some of the alternatives are even more dangerous.

My Mom is 100lbs overweight, has type diabetes, takes metformin, and injects insulin into her belly every night. She has read the Obesity Code, and even tried intermittent fasting with a lower carb diet, and was able to drop her insulin in half in just a few weeks with well controlled blood sugar. Her doctor put a quick stop to that. He said that intermittent fasting was dangerous. She believes him. She’s injecting even more insulin now than she was before. She has heart problems due to obesity and won’t even consider plain old keto. It’s really frustrating.

There is so much money involved, it’s hard to imagine the American Medical Association will be pushing to change public perception any time soon. Diabetes alone is a $327 Billion annual cash cow… :frowning:

(Ilana Rose) #15

This is so insane. My grandparents generation had loads of intermittent fasting, it just wasn’t called that. It’s amazing how divorced doctors have become from even our most recent diet history.

I feel your pain re fasting and talking to family. My family already thinks I’m insane and have an eating disorder because of keto and OMAD. I was completely honest early on, but now I wish I hadn’t been. I’m not going to even think of telling them I’m doing carnivore…lol.


I have a mom who loves everything fat, and suspects it’s because she never got enough in her childhood. She’s the only one in my family who does extended fasts (1-2 weeks) every once in a while, and very lazy keto-ish eating. She’s 67, and is more flexible and does way better squats than most school kids.

I’ve been somewhat lucky with my family. The parents have never said fat is bad, except when my dad stopped me from eating only cod liver for dinner (was afraid of vitamin poisoning). Instead they told me to eat less sugar and bread. And many older doctors will tell people to eat what their grandparents ate, if they want to be healthy.

(Complete legend) #17

Can you institute this for everywhere but the not-eating sub-foums on here, please?


(The amazing autoimmune 🦄) #18

Before I found Keto I investigated bariatric surgery and I found this information. My PC suggested thinking about it and I pointed out the high death rate for an elective surgery. He said that it had the highest rate of success for weight loss.

I have several friends who have had this surgery and both have had serious problems directly caused by the surgery . Another colleague’s wife passed away from the surgery.

My husband is really steamed that the doc never even mentioned the idea of a ketogenic diet.

(aka Nick) #19

It’s awful that that happened to your friends and colleague’s wife. I’ve heard some terrible stories about complications, but it’s never hit that close to home for me. I’m really glad you found keto!

I’ve got a friend who is a nurse at a state run nursing home, and she’s told me some terrible stories about bariatric surgery. All of her patients are elderly, and many are obese. Although they have total dietary control over these folks, they still push the surgeries on a high % of them knowing that the highest risk factor for bariatric surgery is age.

She says the complications are terrible, and that many patients die from them. They just keep pushing patients one after the other through the sales pipeline, I mean healthcare system. The same couple of surgeons stay very, very busy. She reckons they’ll keep doing as many as possible as long as medicare keeps sending 5 figure checks.

Based on the this study, a little over 3% of the patients over the age of 65 die within 30 days of the surgery! That just seems doesn’t seem right.

(The amazing autoimmune 🦄) #20

That is terrible.

Whatever happened to the “and do no harm”