DS math

Now thats my man...........

diana how does the DS change metabolism to correct insulin resistance? just curious?

kf

From Dr. Husted's website:

Metabolic Effect: In addition to the effect of dietary restriction and malabsorption, Duodenal Switch has a metabolic effect to affect weight loss and improvement in health as well. The portion that food passes through - the alimentary limb - has the ability to absorb protein and sugars. This portion of intestine also has the ability to secrete a hormone - GLP-1, or Enteroglucagon - in the presence of undigested food. Since this portion of intestine is presented to undigested food earlier on as a result of the anatomic re-arrangement induced by Duodenal Switch, secretion of GLP-1 is enhanced. Enteroglucogan (GLP-1) has the effect of suppressing the secretion of insulin in response to a carbohydrate meal, resulting in a lesser amount of ingested carbohydrates being converted to body fat.

The portion of intestine that is bypassed holds an important role as well. Enterogastrone is a hormone that is secreted by the upstream small intestine when food passes through it. This hormone has the effect of converting food to fat. When the upstream portion of the intestine is bypassed - as is the case with Duodenal Switch - enterogastrone secretion is suppressed. The effect of this bypass is that the patient's body after Duodenal Switch has less of a tendency to convert food to fat.

A simplified way to explain the sum of these metabolic effects is that the patient after Duodenal Switch takes on the metabolism of a lean individual. We all know people who are able to eat large amounts of food, and yet are able to maintain a lean physique. These people have a metabolism that tolerates a sizeable caloric intake without resulting in obesity, yet their bodies are able to maintain normal protein levels and keep from becoming malnourished. Patients undergoing Duodenal Switch are able, for the most part, to eat normal amounts of food, but they must eat healthy foods if they are to keep from becoming malnourished. Duodenal Switch patients can't eat junk food all day and expect to remain healthy; with the freedom they have in eating freely, they must exercise responsibility in order to keep from becoming malnourished. Most patients after Duodenal Switch take in anywhere from 80 to 100grams of protein in their diet each day in order to remain healthy. You can't get this level of high quality of protein eating junk all day, but if one chooses to after Duodenal Switch, they can, due to the relatively ability to eat freely.

 

Here is a very good, albeit technical explanation: http://info_ltd.tripod.com/infos/potential_of_surgery_for_cu ring_type_2_diabetes_mellitus.htm What this boils down to, is that the DS IMMEDIATELY (and not through weight loss) changes the metabolism in a number of ways.  Which one or ones cause the correction of insulin resistance isn't yet fully understood, and there may be additional reasons that have not yet been discovered, but they include: *exclusion of duodenum and at least part of the jejunum from the transit of food, which has the following consequences:   -- undigested or incompletely digested food is presented early to the ileum, and    -- the duodenum and jejunum are excluded from the enteroinsular axis * a change in the pattern of secretion of gastrointestinal hormones * exclusion of the site responsible for the production of the hormone causing type 2 diabetes; thus:   -- hyperinsulinemia in type 2 diabetes is the result of an abnormal incretin signal from the gut,   --  insulin resistance is a secondary protective phenomenon * a hormone overproduced in the proximal foregut in diabetic patients might not directly increase the production of insulin, but rather counteract the action of insulin, thus inducing insulin resistance and only secondarily hyperinsulinemia *  chronic exaggerated stimulation of the proximal gut of susceptible people with fat and carbohydrates may induce overproduction of an unknown factor that causes impairment of incretin production and/or action, leading to insufficient or untimely production of insulin so that glucose intolerance develops   -- bypass of the duodenum and jejunum avoids this phenomenon, while   -- the early presentation of undigested or incompletely digested food to the ileum may anticipate the production of hormones such as glucagon-like peptide 1 (GLP1), further improving insulin action

pretty interesting even though i am nurse i had to read it very slowly to wrap my mind around it i have heard that the ds is a great surgery for people who;s wt is threatening their life

because it works so effectively

i have also heard that if you are a "light wt" it isnt the best because the wt loss is so rapid and can cause you to be "underwt"  is that true? kf

Another misconception. The DS can be tailored to the patient.  The stomach portion can be made between 2 - 8 oz (or larger, though I haven't heard of the value of bothering to operate if the stomach would be left any larger); the amount of intestine in the alimentary vs. biliopancreatic limb can be varied; and of course the common channel can be anywhere from 50 (for diabetics in particular) to 150 cm or even more. While it is an inexact science, these kinds of variations can be selected to make the DS appropriate for people with BMIs from 35 to 100+.  And if the patient starts to lose too much, there are interventions short of surgery that can be very effective: (1) start eating more sugar and carbs (that's a tough one, huh?), and (2) take pancreatic enzymes (Creon) that help the intestines absorb more protein and fat, until the weight loss stabilizes.  Finally, as a rarely used last resort, the length of the common channel can be lengthened in a rather simple laparoscopic procedure, by moving the connection point of the biliopancreatic limb further distal on the ilium. Good questions, and thanks for the opportunity to dispell these kinds of myths!

I was a lightweight (42 BMI).  I've done fine with the DS and am by NO MEANS underweight.  The DS can be ridden "with the brakes on" by adding carbs to the diet in MOST cases.  I just rode my brakes!  hehe!

Not even in pre-op life could I eat 3000 cal. When I over viewed the DS while I found somethings worth it the huge cal intake I found impossible for me. I wanted to control my weightloss and I found that in the end DS would control me. That is how I saw it. Myself I am happy with not having a focus on food and eating very little. In a day I might eat 1200 cal pretty much what I had been eating before hand only now the food is working for me. I also like NOT having folks force food on me as they use to do. I was a diabetic for a while and they learned to stop trying to get me to eat sweets. And yes I have a family that just loves to keep at you to eat. Now they leave me the hell alone. I control my weight and no longer focus on the food. I use my extra time for fun, work and myself. I now loose as much as I want and keep it off. I have many times stalled on purpose to be sure I can control my weight. Alright for me this works for others well other things work. The main things is not any one thing is perfect or the end all for everyone. We have to find what works for us and stay with it. I do not condem any tool used to help a person be in control of their weight. The only thing I object to is those who say "This is the end all." "You are being cheated if you don't do this." What works for you use no matter what other say. Yes be informed but don't let folks force their ajenda on you. Listen to what is right for you and what you want to do. I know some won't agree with me and good for them. We all have a right to agree or disagree and I support that. But we also need to be nice to each other.  Information is one thing but also listening to why others don't agree or can't do as you wish is true caring and understanding. - Jaz

I agree that this is the general forum where all kinds of WLS options can be discussed, but I still don't understand why DS patients seem to be on some kind of campaign to convert the world to their viewpoint!  If you want newbies to be aware of DS, why not just post something like: "be sure to check out the Duodenal Switch on the DS forum"? You don't hear me preaching about the superiority of the Lap-Band, even though it has been a superior solution for me and many others.  If you want to know why I chose it over the other options and am happy with my choice, you can PM me. Jean

Jean, you are ONE CLASS ACT!