Where do the calories come from?

Hello everyone,

I'm exploring the DS right now and I was hoping you fine folks could help me out with something.

I've been reading Dr. Buse's blog and he has some interesting posts about how much of the food he eats is actually absorbed.

Now I understand malabsorption is one of the major benefits of DS during weight loss, but what about during maintanence? It seems like one would have to eat a lot of food to get the necessary calories needed just to survive. Occasionally I've seen posts on here about people losing too much weight, so I guess it does happen, but it seems pretty rare.

I ran some numbers using a Basal Metabolic Calculator. I realize these things aren't exact, but they get us in the ballpark in terms of calories needed to maintain life.

So here are the assumptions. I'm 5'8", male, and with a goal weight of, say, 155 pounds.To maintain that weight, I would need to eat 1,988 calories (per the calculator). And that's if I was completely sedentary. Assuming I'm moderately active (which I'd like to be), BMR goes up to 2568.

Now, those are the calorie counts for a non-switched person. Am I understanding things correctly that a similar switched person would probably need to eat somehwere around 4,000 calories to maintain (due to malabsoprtion).

I've been reading this forum a lot and I haven't seen much discussion about this, so I guess it's not an issue. I guess I'm trying to understand WHY it doesn't seem to be a problem.

I'm sure I could eat 4,000 calories a day. Hell, I'm probably eating more right now, but I guess I wish I wouldn't have to eat that much food. Also, am I correct in assuming that the more food you eat, the more likely you might have problems with bowel movements?

Thanks for reading. 

Maintenance is going to vary a lot person to person.  Some never quite reach goal, some lose below goal.  Some struggle to maintain, some do so effortlessy.

I've been one of the lucky ones who lost a smidge past my goal (not too thin, though) and have effortlessly maintained for about a year now.  My sleeve has definitely stretched and I can eat about what I ate as a pre-op.  Getting in enough calories is NOT a problem for me!

Some people have bathroom issues if they eat too many carbs or too much fat, but that can easily be modified to control those issues.  There are no issues from too much food in general (that I know of).

It doesn't take any effort at all to consume 4,000 calories a day when you are able to eat without regard to fat content. Try figuring out how much you're really eating now.

The poop factor generally has to do with how you react to fat and carb intake, not so much with volume consumed.

Its not hard at all. I drink 1000 calories a day in protein shakes. That is half and half and 6 scoops of protein. PLUS my food on top of that. I probably intake 2000-2500. I'm pretty active, I work out regularly, work and have 3 small kids.

 I'm certain calorie absorption rates vary from patient to patient based on surgery stats (e.g. common channel length) and length out in year from surgery due to intestinal adaptation.  Based on available data, most subscribe to the malabsorption rate of 80% for fat and 40-50% for protein and complex carbs.  

For my general purposes, I calculate my caloric intake based on an 20% fat absoroption (0.2 x 9 cal/gm), a 60% protein/complex carb absorption (0.6 x 4 cal/gm), and 0% malabsorption for simple sugars (4 cal/gm), simple carbs (4 cal/gm), and alcohols (7 cal/gm).  So, for me, based on the above, the caloric values I use are:

1.8 cal/gram for fats
2.4 cal/gram for protein
2.4 cal/gram for complex carbs
4    cal/gram for simple carbs
4    cal/gram for simple sugars
7    cal/gram for alcohols.

Having said that, I rarely (if ever) count my calories.  My goals are to get in as close to 200 gm of protein per day (480 calories).  I also eat upwards of 200 gm of fat daily (360 calories; heavy cream's the major culprit).  That's 840 calories for the day right there.  As long as I subscribe to the philosophy of protein first, fats second, complex carbs third, simple sugars/carbs fourth, and alcohols last (highest caloric content with zero nutritive value) I don't have any troubles from a weight management standpoint or GI side effect standpoint.  I'll still get oil slicks if I overdo the fat.  If that happens, I slack off a bit.  I still get in a healthy dose of complex carbs.  I don't shy away from dessert.  I like a glass of wine on occasion (had 2 last night).  

Things may change the further out from surgery I get, but I have every faith in my DS's malabsorptive power.  Even if the percentages of absorption change a bit in the future based on my intestine's adaptation to surgical change I'll still subscribe to the same eating habits outlined above but maybe change my proportions some.  

I eat a lot calorie-laden foods throughout the day; I get a large volume of calories in a relatively small amount of foods/beverages.  One large cup of coffee with heavy cream, depending on how heavy-handed I am, can have 700 calories (of which I will absorb about 140 cal).  When I do protein drinks, I can get a lot of protein in a small, non-dense volume.  Nuts are calorie-packed also.  What I'm trying to drive home is the point that I don't have to walk around pushing a grocery basket with my mountain of groceries in it for the day (unless I choose to).   

I'm at a phase in my DS life (coming up on 2 years) where I've been constantly steady within about 4 pounds all the time regardless of diet and activity level.  I exercise because I want to and certainly not because I have to in order to maintain my pesent weight.   My percentage body fat has gone from 42% preop to a current 6%.  I'm loving my DS life and wouldn't have it any other way. 

"For my general purposes, I calculate my caloric intake based on an 20% fat absoroption (0.2 x 9 cal/gm), a 60% protein/complex carb absorption (0.6 x 4 cal/gm), and 0% malabsorption for simple sugars (4 cal/gm), simple carbs (4 cal/gm), and alcohols (7 cal/gm).  So, for me, based on the above, the caloric values I use are:

1.8 cal/gram for fats
2.4 cal/gram for protein
2.4 cal/gram for complex carbs
4    cal/gram for simple carbs
4    cal/gram for simple sugars
7    cal/gram for alcohols."




You're such a geek.

Thanks for the responses everyone. Especially the doc. I'm glad to see you blogging again, too.

I want to add something that I haven't yet seen others mention: those of us who have been morbidly obese have messed up metabolisms. 2 people of the same sex, height, weight, and muscle mass will still burn different amounts of calories; if one of them had previously weighed 50 pounds more and lost the weight, then that person will almost undoubtedly require FEWER calories than the one who had never been overweight to begin with. So, calorie calculators are really not very likely to even get in the "ballpark" of what you'll really need after living a calorie-restricted life (via restriction and then malabsorption) for many months and losing a significant amount of weight.

I highly recommend not counting calories. It will just end up being confusing and likely frustrating because the body does not work based on math  :)