Sleeve gastrectomy causes autoimmune diseases and fibromyalgia.
Original statement
التكميم يعمل فايبروميولجيا
verbatim according to source. Translation by the project; the Arabic wording is authoritative.
Translation
Sleeve gastrectomy causes autoimmune diseases and fibromyalgia.
Origin
- Source status
- Video transcript (own words)
- Attribution
- Elawady (machine transcript)
- Video
- Dr Diaa Al Awady د ضياء العوضي is live! مقاومة الأنسولين ٢ (Open source)
- Published
- 1 July 2025
- Timestamp
- not available (transcript has no timings)
- Attribution uncertainty
- Archive transcript (YouTube CC or AI-generated); wording may contain transcription errors; no timestamps available.
- Claimed mechanism
Undigested food, abdominal pressure and inflammation.
- Claimed health effect
Autoimmune disease, fibromyalgia.
- Population concerned
Sleeve patients
- Geographic restriction by Elawady
none found
Diverging source versions
- Source status
- Video transcript (own words)
- Attribution
- Elawady (machine transcript)
- Video
- اتفرجوا عالبودكاست ده وقولولي رأيكوا عشان انزلكوا الحلقه التانيه منه (Open source)
- Published
- 9 April 2026
- Timestamp
- not available (transcript has no timings)
- Attribution uncertainty
- Archive transcript (YouTube CC or AI-generated); wording may contain transcription errors; no timestamps available.
Scientific assessment
Potentially false – The available evidence tends to speak against the statement, but is not conclusive.
Certainty of evidence: low – Further research is likely to change the assessment considerably.
1. What was claimed?
Sleeve causes autoimmune disease and fibromyalgia.
2. What is demonstrably correct?
There is an observational signal for one immune-mediated disease: inflammatory bowel disease, especially ulcerative colitis, was diagnosed more often some years after sleeve gastrectomy in Swedish (I-BAR-138) and US (I-BAR-139) cohorts; absolute risk remains small (about 6 per 10,000 per year) and causation is not established.
3. What is wrong or exaggerated?
The general claim that sleeve gastrectomy causes autoimmune diseases is not supported: no increase in rheumatoid arthritis was found over up to 29 years (I-INTC-09). For fibromyalgia, the available evidence points in the opposite direction: obesity is associated with worse symptoms and weight loss, including surgery, may improve them (I-INTC-11).
4. What remains unclear?
Data specific to sleeve gastrectomy are scarce; the SOS surgery group had gastric banding (19%), vertical banded gastroplasty (68%) and gastric bypass (13%) and no sleeve gastrectomy at all, rheumatoid arthritis was not a predefined endpoint, and the authors state the study may be underpowered (I-INTC-09). The frequency of de novo IBD after surgery compared with the expected rate is unknown. Other autoimmune diseases were not studied in the sources found.
5. Which studies support it?
I-INTC-10 (de novo IBD reported), I-BAR-138, I-BAR-139.
6. Which studies contradict it?
I-INTC-09 and I-BAR-140 (no increase in RA); I-INTC-11 (weight loss including bariatric surgery may improve fibromyalgia).
7. What applies to Germany and Europe?
Most key data are European (Sweden SOS/SOReg, Finland SLEEVEPASS, Switzerland SM-BOSS). European and international society guidelines consider bariatric surgery for severe obesity with lifelong follow-up.
8. What is known about Egypt?
No Egypt-specific outcome data were identified in this review. Elawady states in a transcript that sleeve gastrectomy is very widely performed in Egypt ('مصر كلها بتعملها'); the procedure-specific risks (reflux, deficiencies) apply wherever it is performed, and follow-up quality (supplements, endoscopy, mental-health screening) determines part of the risk.
9. What practical conclusion is appropriate?
Fear of autoimmune disease or fibromyalgia is not, on current evidence, a reason to reject bariatric surgery; the established risks (reflux, deficiencies, need for follow-up) should be discussed with the surgical team.
Assessment details
- Rationale for certainty of evidence
No increase in rheumatoid arthritis in SOS over a median of 21 years (HR 0.92, 0.59-1.46; I-INTC-09) or in an Israeli matched cohort (9 vs 9 cases; I-BAR-140). Fibromyalgia: no incidence data after surgery were found; weight loss may improve symptoms (I-INTC-11). Inflammatory bowel disease: two large cohorts report associations after sleeve (ulcerative colitis HR 1.8 vs general population, I-BAR-138; IBD aHR 2.28 after 3 years vs obese controls but 0.76 in the first 3 years, I-BAR-139), with small absolute risk and possible detection bias. Evidence is observational and largely not sleeve-specific, so certainty is low.
- Source quality
Assertion without cited data.
- Regional transferability
n/a
- Individual exceptions
n/a
- Regional scope of the claim
- general (biological/medical)
- Last reviewed
- 26 October 2026 provisional
Scientific evidence in detail
Overinterpreted – A real finding exists, but the claim draws more from it than the data allow (e.g. association taken as cause, animal data applied to humans, small effect presented as large).
Research question: Does sleeve gastrectomy cause autoimmune diseases or fibromyalgia?
Research question in detail (PECO)
- Population
- Adults after sleeve/bariatric surgery
- Intervention or exposure
- Sleeve gastrectomy / bariatric surgery
- Comparison
- Matched obese or general-population controls
- Geographic scope
- universal biology
- Outcomes
- Incident autoimmune/immune-mediated diseases (RA, IBD)
- Fibromyalgia
Study results as reported by the authors. Our assessment follows below.
What speaks for the claim?
Swedish study: bowel inflammation after obesity surgery
Kiasat et al.. Surg Obes Relat Dis 2022 · PMID 35012883 · DOI 10.1016/j.soard.2021.12.014 Cohort studyabstract checkednewly addedSwedish nationwide cohort: ulcerative colitis more often after sleeve than in the general population.
- Actual result
- SG UC HR 1.8 (1.1-3.1).
- Methodological quality
- moderate (confounded by obesity)
- Relevance
- direct for one immune-mediated disease
- Limitations
- General-population controls
US study: bowel inflammation after surgery
Pusateri et al.. Obes Surg 2026 · PMID 42082785 · DOI 10.1007/s11695-026-08714-1 Cohort studyabstract checkednewly addedUS claims cohort: IBD risk higher after 3 years post-surgery (especially sleeve) vs obese controls, lower in first 3 years.
- Actual result
- Late aHR 2.28 (1.02-5.06); early aHR 0.76.
- Methodological quality
- moderate
- Relevance
- direct
- Limitations
- Claims data, imprecise
What speaks against the claim?
Weight-loss surgery and rheumatoid arthritis
Maglio C et al.. Rheumatology (Oxford) 2020 · PMID 31321442 · DOI 10.1093/rheumatology/kez275 Cohort studyfull text, structured risk-of-bias assessmentSOS: no increase in rheumatoid arthritis over a median of 21 years.
- Actual result
- HR 0.92 (0.59-1.46).
- Methodological quality
- moderate
- Relevance
- indirect (no sleeve)
- Limitations
- Underpowered
Israeli study: rheumatoid arthritis after surgery
Jeries et al.. Rheumatol Adv Pract 2026 · PMID 41908723 · DOI 10.1093/rap/rkag025 Cohort studyabstract checkednewly addedIsraeli matched cohort: same RA incidence with and without surgery.
- Actual result
- 9 vs 9 cases.
- Methodological quality
- low
- Relevance
- direct
- Limitations
- Few events
Fibromyalgia and obesity
D'Onghia M et al.. Semin Arthritis Rheum 2021 · PMID 33676126 · DOI 10.1016/j.semarthrit.2021.02.007 Meta-analysisabstract checkedFibromyalgia: obesity worsens symptoms; weight loss including surgery may improve them.
- Actual result
- Obesity prevalence 35.7% in FM; preliminary benefit of weight loss.
- Methodological quality
- low
- Relevance
- indirect
- Limitations
- High risk of bias
What does the overall evidence say?
Editorial assessment based on the studies above – not itself a study result.
Which position is better supported?
No evidence that sleeve causes autoimmune disease in general or fibromyalgia; a modest observational signal exists for inflammatory bowel disease (mainly ulcerative colitis) after sleeve, with very small absolute risk and unproven causation.
Why some studies weigh more
Two large cohorts for IBD give a signal; RA data consistently null; no fibromyalgia incidence data found.
Is a causal relationship established? Not established IBD signal could reflect detection bias or obesity-related confounding.
Remaining uncertainty
IBD mechanism; other autoimmune diseases unstudied.
Justified conclusion
Probably false as a general claim; IBD part is a real but small, unproven signal.
Why do studies seem to disagree?
Early lower and late higher IBD risk (I-BAR-139) and procedure-specific patterns (I-BAR-138) suggest complex or artefactual associations.
Does this depend on the country?
- General biological effects
- Universal.
- Eating habits
- Not applicable (surgical procedure, not a food).
- Origin of the food
- Not applicable (surgical procedure, not a food).
- Contaminants
- Not applicable (surgical procedure, not a food).
- National production conditions
- Not applicable.
- Legal rules
- Not applicable.
- Actual monitoring data
- No Egyptian data found.
A regional difference that changes the conclusion is not supported by robust data.
Statistical re-check
- Absolute rate difference – IBD 61.2 vs 44.4 per 100,000 per year: excess ~17 per 100,000 per year (crude). recalculated
Certainty of the overall evidence (GRADE, simplified)
- Main outcome
- Incident autoimmune/immune-mediated disease after sleeve
- Starting level
- low (observational studies)
- Reasons for downgrading
- inconsistency
- imprecision
- indirectness (fibromyalgia not studied)
- Result
- low
Simplified assessment by a single reviewer, following the GRADE approach; not a formal GRADE panel. GRADE rates the body of evidence for one outcome, not individual studies.
Search strategy
Documented literature searches for this review (search strings in the original database syntax).
| Database | Date | Search | Looking for | Hits | Included |
|---|---|---|---|---|---|
| Europe PMC | 26 October 2026 | (TITLE:"autoimmune" OR TITLE:"fibromyalgia" OR TITLE:"inflammatory bowel disease" OR TITLE:"psoriasis" OR TITLE:"rheumatoid" OR TITLE:"lupus" OR TITLE:"multiple sclerosis") AND (TITLE:"bariatric" OR TITLE:"sleeve gastrectomy" OR TITLE:"metabolic surgery") | both directions | 104 | |
| PubMed | 26 October 2026 | (fibromyalgia OR chronic widespread pain) AND (bariatric surgery OR sleeve gastrectomy OR gastric bypass) | both directions | 423 | |
| PubMed | 26 October 2026 | (autoimmune disease*[tiab]) AND (bariatric surgery[tiab] OR sleeve gastrectomy[tiab]) AND (incidence OR risk) AND (cohort OR matched) | both directions | 0 |
Open questions
Fibromyalgia incidence after sleeve; IBD replication with endoscopy-controlled design.
How deeply was this checked?
6 linked studies: 1 checked in full text (1 of them with a structured risk-of-bias assessment), 5 on the basis of the abstract, 0 bibliographically only. No formal assessment with two independent reviewers and no independent human expert review has taken place yet.
Last scientific review: 26 October 2026
History of the verdict
- 25 October 2026 · Phase 1 · Initial assessment: Potentially false (low)
- 26 October 2026 · Phase 4 (systematic evidence review) · Re-examined with extended evidence; verdict unchanged: Potentially false (low)
Verdict (“Potentially false”) and certainty (low) unchanged. New cohorts strengthen the IBD signal somewhat and confirm no RA increase; review text updated accordingly.
New sources: I-BAR-140 I-BAR-138 I-BAR-139
In plain language
Elawady said that sleeve gastrectomy causes autoimmune diseases and fibromyalgia. A long Swedish study found that weight-loss surgery did not increase rheumatoid arthritis over about 21 years. For fibromyalgia, early studies suggest that losing weight, including through surgery, may ease symptoms. Some reports describe new inflammatory bowel disease after weight-loss surgery, but it is not known how often this happens or whether surgery causes it.
Studies on this claim
Studies supporting the claim (0)
No studies in this group.
Studies contradicting or limiting the claim (3)
-
Weight-loss surgery and rheumatoid arthritis
Maglio C et al.. Rheumatology (Oxford) 2020 · PMID 31321442 · DOI 10.1093/rheumatology/kez275Cohort studyindependent cross-checkfull text, structured risk-of-bias assessment★ key studyOver a median of 21 years, people who had weight-loss surgery did not develop rheumatoid arthritis more often than matched controls.
No increase in rheumatoid arthritis after bariatric surgery (HR 0.92).
Does the study support the specific claim? No · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Test bariatric surgery and RA incidence
- How was the study done?
Matched cohort
- How many people, animals or samples were studied?
4036 adults with obesity
- What was actually found?
No association
- How large was the observed effect?
HR 0.92 (0.59-1.46)
- What do the results mean in everyday life?
Surgery did not raise the risk of rheumatoid arthritis.
- What are the study's limitations?
Few cases; older surgery types; not randomised
- What does it say about Elawady's specific claim?
Contradicts 'surgery causes autoimmune disease' for RA
- Do the results apply to Germany and Europe?
High
- What can explicitly not be concluded from this study?
Effects of sleeve gastrectomy specifically; other autoimmune diseases
-
Fibromyalgia and obesity
D'Onghia M et al.. Semin Arthritis Rheum 2021 · PMID 33676126 · DOI 10.1016/j.semarthrit.2021.02.007Meta-analysisindependent cross-checkabstract checkedAbout one in three people with fibromyalgia has obesity; early studies suggest weight loss, including surgery, may ease symptoms.
Weight loss (incl. surgery) preliminarily improves FM symptoms.
Does the study support the specific claim? No · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Review FM and obesity
- How was the study done?
Systematic review and meta-analysis
- How many people, animals or samples were studied?
41 studies
- What was actually found?
Obesity common in FM; weight loss may help
- How large was the observed effect?
Obesity prevalence 35.7% (31.8-39.9%)
- What do the results mean in everyday life?
Losing weight may help fibromyalgia.
- What are the study's limitations?
High risk of bias; few weight-loss studies
- What does it say about Elawady's specific claim?
Does not support 'surgery causes fibromyalgia'
- Do the results apply to Germany and Europe?
High
- What can explicitly not be concluded from this study?
Proof of benefit or harm from sleeve gastrectomy
-
Israeli study: rheumatoid arthritis after surgery
Jeries et al.. Rheumatol Adv Pract 2026 · PMID 41908723 · DOI 10.1093/rap/rkag025Cohort studyindependent cross-checkabstract checkedRheumatoid arthritis appeared equally rarely in operated and non-operated people (9 cases each).
RA incidence identical (9 vs 9) after surgery and in controls.
Does the study support the specific claim? No · Methodological quality: low · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
RA after surgery
- How was the study done?
Matched cohort
- How many people, animals or samples were studied?
19,166
- What was actually found?
9 vs 9 cases
- How large was the observed effect?
No difference
- What do the results mean in everyday life?
No sign of more arthritis
- What are the study's limitations?
Very few cases
- What does it say about Elawady's specific claim?
Contradicts the RA part
- Do the results apply to Germany and Europe?
Plausible
- What can explicitly not be concluded from this study?
Small effects
No study in this group is marked as key.
Studies with mixed or unclear results (3)
-
Bowel inflammation after weight-loss surgery
Mian A et al.. Surgeon 2023 · PMID 35660070 · DOI 10.1016/j.surge.2022.04.008Systematic reviewindependent cross-checkabstract checkedSome studies report new inflammatory bowel disease after weight-loss surgery, but how often and whether surgery causes it is unknown.
De novo IBD reported after bariatric surgery; causation and rate unknown.
Does the study support the specific claim? Partly · Methodological quality: low · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Review bariatric surgery and IBD
- How was the study done?
Systematic review of 22 studies
- How many people, animals or samples were studied?
Patients with/without IBD
- What was actually found?
Safe in IBD; de novo IBD reported
- How large was the observed effect?
not reported
- What do the results mean in everyday life?
A possible rare link exists but is unproven.
- What are the study's limitations?
Weak study types; no rates
- What does it say about Elawady's specific claim?
Weak partial support
- Do the results apply to Germany and Europe?
High
- What can explicitly not be concluded from this study?
Causation
-
Swedish study: bowel inflammation after obesity surgery
Kiasat et al.. Surg Obes Relat Dis 2022 · PMID 35012883 · DOI 10.1016/j.soard.2021.12.014Cohort studyindependent cross-checkabstract checked★ key studyUlcerative colitis was diagnosed more often after sleeve (and Crohn disease after bypass) than in the general population.
SG associated with UC (HR 1.8) vs general population; confounded by obesity.
Does the study support the specific claim? Partly · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
IBD after surgery
- How was the study done?
Register cohort
- How many people, animals or samples were studied?
698,718
- What was actually found?
SG: UC HR 1.8
- How large was the observed effect?
HR 1.8
- What do the results mean in everyday life?
A possible, small link with bowel inflammation
- What are the study's limitations?
Controls not obese
- What does it say about Elawady's specific claim?
Partly supports immune-disease claim (IBD only)
- Do the results apply to Germany and Europe?
Directly European
- What can explicitly not be concluded from this study?
Causation
-
US study: bowel inflammation after surgery
Pusateri et al.. Obes Surg 2026 · PMID 42082785 · DOI 10.1007/s11695-026-08714-1Cohort studyindependent cross-checkabstract checkedBowel inflammation was less common in the first 3 years after surgery but more common afterwards, especially after sleeve; it remained rare.
Late IBD aHR 2.28 after MBS (esp. VSG) vs obese controls; early aHR 0.76.
Does the study support the specific claim? Partly · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
IBD timing after MBS
- How was the study done?
Claims cohort
- How many people, animals or samples were studied?
477,687
- What was actually found?
Late aHR 2.28
- How large was the observed effect?
61 vs 44 per 100,000/y
- What do the results mean in everyday life?
Small possible risk
- What are the study's limitations?
Claims data
- What does it say about Elawady's specific claim?
Partly supports IBD part
- Do the results apply to Germany and Europe?
US
- What can explicitly not be concluded from this study?
Causation
No study in this group is marked as key.
Regional context
Germany / EU
Most key data are European (Sweden SOS/SOReg, Finland SLEEVEPASS, Switzerland SM-BOSS). European and international society guidelines consider bariatric surgery for severe obesity with lifelong follow-up.
Egypt
No Egypt-specific outcome data were identified in this review. Elawady states in a transcript that sleeve gastrectomy is very widely performed in Egypt ('مصر كلها بتعملها'); the procedure-specific risks (reflux, deficiencies) apply wherever it is performed, and follow-up quality (supplements, endoscopy, mental-health screening) determines part of the risk.
What applies in my country?
General scientific assessment
Potentially false Probably false as a general claim: no increase in rheumatoid arthritis and no evidence for fibromyalgia caused by surgery; a modest, unproven association with inflammatory bowel disease exists.
This statement concerns biological or medical relationships. The scientific assessment above applies regardless of the country; country-specific food data do not change it.
References
- Bariatric surgery and the incidence of rheumatoid arthritis - a Swedish Obese Subjects study.. Maglio C et al.. Rheumatology (Oxford) 2020 · PMID 31321442 · DOI 10.1093/rheumatology/kez275
- Fibromyalgia and obesity: A comprehensive systematic review and meta-analysis.. D'Onghia M et al.. Semin Arthritis Rheum 2021 · PMID 33676126 · DOI 10.1016/j.semarthrit.2021.02.007
- The association between bariatric surgery and incident rheumatoid arthritis.. Jeries et al.. Rheumatol Adv Pract 2026 · PMID 41908723 · DOI 10.1093/rap/rkag025
- Systematic review: Outcomes of bariatric surgery in patients with inflammatory bowel disease and de-novo IBD development after bariatric surgery.. Mian A et al.. Surgeon 2023 · PMID 35660070 · DOI 10.1016/j.surge.2022.04.008
- The risk of inflammatory bowel disease after bariatric surgery.. Kiasat et al.. Surg Obes Relat Dis 2022 · PMID 35012883 · DOI 10.1016/j.soard.2021.12.014
- The Impact of Metabolic Bariatric Surgery on Inflammatory Bowel Disease Risk and Outcomes in Adults With Obesity: a Propensity-matched, Nationwide, Analysis.. Pusateri et al.. Obes Surg 2026 · PMID 42082785 · DOI 10.1007/s11695-026-08714-1