swizzly

NO calorie malabsorption??

27 posts in this topic

I was just reading this post by Dr Callery and it freaked me out if I'm honest. Even though I ended up having VSG, I contemplated GBS for many years. One of the reasons GBS always appealed to me was this whole idea of having a period of time ("active weight-loss phase" as Kel says, or "the honeymoon period") where you ate little (small pouch) PLUS absorbed fewer calories from what you did eat. But if I'm reading him right, Dr Callery is saying there is in fact no calorie malabsorption at all? Am I just just misunderstanding what he's saying?

This seems pretty straightforward: "After a gastric bypass you will probably still absorb 100% of the calories that you eat." But he also mentions that GBS "makes the digestive process less efficient" -- and I don't understand what that means really.

If that is the case, what is the point of bypassing any part of the intestine anyhow, given the risks associated with possibly not absorbing enough of some nutrients? (I'm talking only about standard GBS, not the 'distal' bypasses and DS, which do bypass a significant part of the intestine.) It kind of makes me angry if they are doing this "gold standard" procedure on so many people, and the actual benefits and risks are not that well-communicated. Granted, I may just be completely misunderstanding or out of the loop, but it was enough to cause me concern, so I thought I'd ask about it.

Edited by swizzly

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I actually did a follow up question regarding this. All of the literature I read says we absorb fewer calories.

Web MD: "Gastric bypass

Gastric bypass surgery makes the stomach smaller and allows food to bypass part of the small intestine. You will feel full more quickly than when your stomach was its original size, which reduces the amount of food you eat and thus the calories consumed. Bypassing part of the intestine also results in fewer calories being absorbed. This leads to weight loss.

Medline Plus: "Your diet after gastric bypass surgeryURL of this page: http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000173.htm

.You had gastric bypass surgery. This surgery made your stomach smaller by closing off most of your stomach with staples. It changed the way your body handles the food you eat. You will eat less food, and your body will not absorb all the calories from the food you eat.

Laproscopic MD "This technique is called a roux-en-Y intestinal bypass. Once in place, food passes from the stomach pouch directly into the jejunum, bypassing the duodenum. Because of this bypass, there is reduced absorption of calories and nutrients

ASMBS assocation say "Treatment of morbid obesity and obesity related disease and condition: limits the amount of food the stomach can hold and/or limits the amount of calories absorbed.

If this was true then why not just have the lap band instead of the gastric bypass.

I don't understand why he said this when all of the literature says otherwise.

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So it's funny that you write this post now, because I just had my 3 month appt with my NUT and asked how long the malabsorption lasts approx. and she said that the newest studies and research show that we are in fact absorbing all of the calories ingested and I didn't think about it then but I did question why they would bypass the intestine also if not necessary. I'm interested in hearing more about this, I mean what's done is done now but i would still like to know what the deal is.

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I have looked all over the internet and I can not find anything that states we do not malabsorb. Everything states that we do for up to 18 to 24 months after the surgery.

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So it's funny that you write this post now, because I just had my 3 month appt with my NUT and asked how long the malabsorption lasts approx. and she said that the newest studies and research show that we are in fact absorbing all of the calories ingested and I didn't think about it then but I did question why they would bypass the intestine also if not necessary. I'm interested in hearing more about this, I mean what's done is done now but i would still like to know what the deal is.

My doctor and I had this conversation and neither of us were convinced of malabsorbing calories....but you have to remember that calories are different than nutrient. As for why we bypass "some" of the intestine...it has to be because of convenience. Frankly, its just the best place to reattach to...not really bypassing the intestine...you are just connecting it directly to the new pouch and still allowing the old stomach to empty like it normally should. The only calorie limitations come from volume restriction (making the pouch)...not from malabsorption. Otherwise we wouldnt worry so much about drinking our calories.

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why not just do a vsg if it does not change the absorbtion? Does not really make sense to me.

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why not just do a vsg if it does not change the absorbtion? Does not really make sense to me.

Actually, per my doctor, it was up to me. So, personal choice really was what went into my decision. I looked at the pros and cons of both and decided RNY was for me. Statistically, they both have the same successes and failures. We all like to have choices instead of no other options.

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We all like to have choices instead of no other options.

A very good point, not to be underestimated. One size doesn't fit all, for sure.

I'm just a little twitchy on topics like this, since us obese people are targeted for so many diets, special foods, drugs, etc., that all cost loads of money, may or may not be safe, and may or may not work. I have an issue with being treated like a guinea pig population, so when I read Dr Callery's post, it kind of touched a nerve.

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My doctor and I had this conversation and neither of us were convinced of malabsorbing calories....but you have to remember that calories are different than nutrient. As for why we bypass "some" of the intestine...it has to be because of convenience. Frankly, its just the best place to reattach to...not really bypassing the intestine...you are just connecting it directly to the new pouch and still allowing the old stomach to empty like it normally should. The only calorie limitations come from volume restriction (making the pouch)...not from malabsorption. Otherwise we wouldnt worry so much about drinking our calories.

You are saying that the reason to bypass some of the intestines is because of convenience. So why not just have a band, it restricts the amount of food we can eat thus volume restriction. A bypass is done because of restriction and malaborption. Why would they do this just to prevent us from absorping nutrients, vitamins etc. I would go by what the ASMBS says.

Calories are contained in the nutrients themselves (fats, proteins, carbs) Calories are a measure of the energy contained in various nutrients, so if you can't absorb the nutrient I would think it would be difficult to get the calories. Nutriient comes from calories. I know high calories foods with high sugar, excess fat and the bad carbohydrates tend to be higher in calorie and less nutrients which can prevent weight loss and/or weight gain.

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Any malabsorption from calories wouldn't last for long anyway.

The body is a miraculous thing and our intestines grow additional villi to compensate for the RYN's bypass. Villi are finger-like projections in the small intestine that help absorb food more efficiently in the body.

The gastric band and the VSG are purely restrictive procedures. Although the VSG wasn't an optoin when I had my WLS, the band would have been but I decided that I needed the the additional help of the RNY in that it generally brings a level of intolerance to too much sugar and fats.

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You are saying that the reason to bypass some of the intestines is because of convenience. So why not just have a band, it restricts the amount of food we can eat thus volume restriction. A bypass is done because of restriction and malaborption. Why would they do this just to prevent us from absorping nutrients, vitamins etc. I would go by what the ASMBS says.

Calories are contained in the nutrients themselves (fats, proteins, carbs) Calories are a measure of the energy contained in various nutrients, so if you can't absorb the nutrient I would think it would be difficult to get the calories. Nutriient comes from calories. I know high calories foods with high sugar, excess fat and the bad carbohydrates tend to be higher in calorie and less nutrients which can prevent weight loss and/or weight gain.

Yes, its just the best place to make the connection. There are theories about ghrelin, a hormone secreted in the fundus of the stomach responsible for appetite and telling us when we are hungry or full. When you have RNY and to a lesser extent in VSG, a portion of the cells responsible for secreting ghrelin are removed from the eating process....those cells stay in-tact in banding as food will pass over them once through the band opening. This causes a larger difficulty for some people with bands because they never get control of their "real" hunger. This could be a reason why RNY and VSG have similar success rates in the 70-80% of ideal body wieght range. Whereas the band is in the 30-40% of ideal body wieght reange. I should have been more specific when I stated nutrient as you are correct that protein, fat, and carbs contain calories and are in fact nutrient. I should have said vitamin and mineral...which were the nutrients I was speaking of. They are in fact malabsorbed, not all but alot of them, because the primary site for absorption for them is in the original stomach...not the intestine. We start to absorb calories in the mouth, and that occurs all the way down the GI, well into the large intestine and even in the colon. Vitamins and minerals are only absorbed in very specific places along the way down.

Of course alot of the above mentioned information is theory as is alot of medicine and hasnt been completely proven. We just think that is what is going on.

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A RNY bypasses all of the duodenum and part of the jejunum - that's where most of our vitamins and minerals were absorbed.

This is a graphic showing what's absorbed where, published in "Advanced Nutrition and Human Metabolism" (Sareen S. Gropper, Jack L. Smith, James L. Groff. Page 51, figure 217:

whatsabsorbedwhere.jpg

AliRn79, gnaed and cinwa like this

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Thanks for the diagram! That shows exactly what we were saying. Im too lazy to look stuff like that up!

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A RNY bypasses all of the duodenum and part of the jejunum - that's where most of our vitamins and minerals were absorbed.

This is a graphic showing what's absorbed where, published in "Advanced Nutrition and Human Metabolism" (Sareen S. Gropper, Jack L. Smith, James L. Groff. Page 51, figure 217:

whatsabsorbedwhere.jpg

cinwa....I am a fairly new kid on the TT block but I already see "WOMAN - YOU ARE DA BOMB" Either yuo are the darndest at internet savvy with LOTS of time to surf or an undercover doctor LOL I stand in awe of your info, sharing and encouragement. I am sure I will look to you for guidance here very soon!

gnaed likes this

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cinwa....I am a fairly new kid on the TT block but I already see "WOMAN - YOU ARE DA BOMB" Either yuo are the darndest at internet savvy with LOTS of time to surf or an undercover doctor LOL I stand in awe of your info, sharing and encouragement. I am sure I will look to you for guidance here very soon!

Thank you! I really appreciate you saying that.

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Excellent additional info, thanks to both of you. I always learn new things here and it's really appreciated. :)

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Great add of info. Makes much more sense now. :lol:

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At a recent follow up I asked my doctor about villi regrowth and she said it doesn't happen. She also said if your tool stops working completely it's due to human error - not measuring or eating the appropriate foods, fluid intake, etc.

As far as malabsorption of calories is concerned, I am not worried. If I use my pouch correctly the caloric intake will be small because the amount of food will be proportional to the size of my stomach. It'd be nice to eat and not have the calories add up, though.

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She also said if your tool stops working completely it's due to human error - not measuring or eating the appropriate foods, fluid intake, etc.

Well, I know for a fact that this isn't true. At all. And four doctors have confirmed this for me. And I've seen it enough times to know humor error is not always "at fault". Our bodies do some wonky things, unfortunately.

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At a recent follow up I asked my doctor about villi regrowth and she said it doesn't happen. She also said if your tool stops working completely it's due to human error - not measuring or eating the appropriate foods, fluid intake, etc.

As far as malabsorption of calories is concerned, I am not worried. If I use my pouch correctly the caloric intake will be small because the amount of food will be proportional to the size of my stomach. It'd be nice to eat and not have the calories add up, though.

According to the Cleveland Clinic:

Patients who have had a part of their intestine removed by surgery undergo a process called intestinal adaptation. During intestinal adaptation, the intestine may grow in size after surgery. The surface area inside the intestine increases as the mucosa (lining of the intestine) becomes thicker. The villi (the lining of the intestine responsible for intestinal absorption) become longer and denser, helping to promote absorption of nutrients. The diameter of the intestine may also increase.

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Corrine, thank you so much for all the info. From everything I have studied our bodies do adapt to the bypass. It's one of the reasons reversals are so difficult. The bypassed intestines retains it's actual size but the part that has been re-attached does grow in size and thickness. When you go to re-attach them they don't match up anymore. I've been studying for my Certification in Bariatric Nursing and this is info I'm expected to know.

In regards to the ghrelin. people who have the VSG experience a large decrease in the amount of ghrelin in their systems. Ghrelin is produced in our stomachs. Since those of us who have had the RNY still retain our remnant stomach, gherlin is still being produced. With the VSG usually about 80% of our original stomach is removed from our body, so a portion of the ghrelin production goes with it.

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I've tried several times to dig up information on how the stomach adapts after post op long term. Searching villi regrowth didn't get me very far. The threads from this forum come up but not much else. Most of the information I've found just gets into the pouch size which is something we all knew from the gate.

Oh and when I bring things up that I do learn, I'm told to stop looking on the internet. Boo that.

Edited by buzzingbees

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cinwa do you have the link to where you clipped that from? I found the cleveland clinic website but only see that quote in relation to short bowel syndrome in children.

http://my.clevelandclinic.org/disorders/pediatric/short_bowel_syndrome/hic-short-bowel-syndrome-in-children.aspx

It's also the same answer to 'What is intestinal adaptation?' here categorized as digestive diseases and disorders: http://www.sharecare.com/question/what-is-intestinal-adaptation

But I can't find it applied to weight loss surgery patients. If my doctor's office is going to nay say, I want to inform myself as best I can.

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I actually did a follow up question regarding this. All of the literature I read says we absorb fewer calories.

Web MD: "Gastric bypass

Gastric bypass surgery makes the stomach smaller and allows food to bypass part of the small intestine. You will feel full more quickly than when your stomach was its original size, which reduces the amount of food you eat and thus the calories consumed. Bypassing part of the intestine also results in fewer calories being absorbed. This leads to weight loss.

Medline Plus: "Your diet after gastric bypass surgeryURL of this page: http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000173.htm

.You had gastric bypass surgery. This surgery made your stomach smaller by closing off most of your stomach with staples. It changed the way your body handles the food you eat. You will eat less food, and your body will not absorb all the calories from the food you eat.

Laproscopic MD "This technique is called a roux-en-Y intestinal bypass. Once in place, food passes from the stomach pouch directly into the jejunum, bypassing the duodenum. Because of this bypass, there is reduced absorption of calories and nutrients

ASMBS assocation say "Treatment of morbid obesity and obesity related disease and condition: limits the amount of food the stomach can hold and/or limits the amount of calories absorbed.

If this was true then why not just have the lap band instead of the gastric bypass.

I don't understand why he said this when all of the literature says otherwise.

I'm so confused too with the contradicting info i even posted a follow up question to that thread quoting Web MD lol

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cinwa do you have the link to where you clipped that from? I found the cleveland clinic website but only see that quote in relation to short bowel syndrome in children.

http://my.clevelandclinic.org/disorders/pediatric/short_bowel_syndrome/hic-short-bowel-syndrome-in-children.aspx

It's also the same answer to 'What is intestinal adaptation?' here categorized as digestive diseases and disorders: http://www.sharecare.com/question/what-is-intestinal-adaptation

But I can't find it applied to weight loss surgery patients. If my doctor's office is going to nay say, I want to inform myself as best I can.

The mechanism for improved absorption is the same for bypassed intestines. But here are references specific to WLS:

"Small intestine starts to work more efficiently - as the body adapts to the gastric bypass the small intestine absorbs more calories and nutrients": http://www.wlshelp.com/lapband-after-gastric-bypass.html

"Your intestines grow additional villi along the intestinal wall -- the little finger-like tentacles that grab nutrients/calories as food passes by...": http://forum.associatedcontent.com/article/1669243/understanding_your_new_rouxeny_gastric_pg2.html?cat=5

" Intestinal Adaptation Following Major Bowel Loss or Bypass (the Mini-Gastric Bypass) The Mini-Gastric bypass results in a major loss of intestinal length and functional capacity. This leads to a major decrease in the digestion and absorption of fat and calories. In animal models of short bowel syndrome following massive loss of bowel, the bowel begins to adapt to the loss of intestine by lengthening somewhat, and more importantly, by increasing in diameter. The number and size of intestinal villi increase, and therefore the absorptive surface area increases.[3] This process occur over 1–2 years and sometimes longer.": http://grou.ps/mgb/talks/1278739

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