Newbie Here and Curious
Thank you so much for your response. Ghrelin is one of the things I am interested in also. I thought initially it was only removed in VSG, and then was told it was removed in both. So this is something I definitely need to research and ask my surgeon about.
Thanks again!
Cynthia
Ghrelin is produced primarily in the outer curvature of the stomach. (A little is produced in other parts of the body.) In the RNY, this part of the stomach is bypassed, meaning it no longer comes in contact with food, but it's still in there. Because it's no longer touching food, in some people it shuts down ghrelin production. In some people, it doesn't.
In the VSG/Sleeve and the DS, that part of the stomach is completely removed from the body, no longer to trouble you. (*grin*)
I know several people IRL with BMI over 50 who are doing quite well with the sleeve and one of them is actually losing at about the same rate that I did with my RNY! She started out at about the same weight I did but is 2 inches taller. She exercises 30 minutes a day 6 days a week, though, whereas I didn't so anything other than walking for at least the first 8 months.
One of the VSG people I know is losing very slowly, but she doesn't make the best food choices (too many carbs) and doesn't exercise at all.
There are a number of people here on OH who have higher BMIs and opted for the VSG and are doing well, and even on a couple of the episodes of My 600 Pound Life the surgeon opted to so a sleeve instead of gastric bypass, so if what you want is a sleeve, don't let anyone "scare" you into going with RNY with a bogus argument about how heavier people should always have RNY (or DS).
If you are committed to the process, you can be successful with VSG, RNY, or DS!
Lora
14 years out; 190 pounds lost, 165 pound loss maintained
You don't drown by falling in the water. You drown by staying there.
Long term, the form of WLS with the very best stats for maintained weight loss is the Duodenal Switch. This is true for patients of any size, but especially so for those of us with a BMI greater than 50. The DS also has the best stats for resolving or preventing diabetes and high cholesterol.
What you really need to figure out is whether your metabolism is just too darned efficient or not. Some of us are born with a 'thrifty' gene that allows our metabolism to 'save' more calories than average people do, and the more we diet, the thriftier our metabolism gets. (Yes, that does indeed suck.)
The VSG causes some minor changes in our metabolism. Recent studies have made this very clear. What's not yet very clear is how lasting those changes are. These changes are most likely due to the removal of about 90% of the stomach.
The RNY causes greater metabolic changes than does the VSG, but not exactly the same ones. In the RNY, none of the stomach is removed, it's just bypassed for food. It's still in there, making digestive enzymes and, occasionally, developing ulcers or cancer. And it can't be 'scoped. This is the primary reason that RNYers are advised to avoid NSAIDs. The secondary reason is the bypassing of the pylorus, replacing it with a stoma which is always open. This is a weak point for the development of what's called marginal ulcers.
The RNY causes metabolic change by bypassing a small portion of the upper end of the small intestine, usually about 100-150 cms. This is all of the duodenum and some of the jejunum. This causes temporary malabsorption of some calories (on average, about 30% of fats, and a smaller per centage of the protein and complex carbs). Unfortunately, the body's very adaptable, and grows extra villi inside the still-fully-functional portion of the intestine, and for most people that means they're back to absorbing protein and carbs pretty normally by 18-24 months post-op. (Some fat malabsorption is permanent, and this means that many RNYers need to supplement the fat-soluble vitamins A, D, E, and K.)
This portion of the small intestine is also where most vitamins and minerals have most of their receptor sites. Those sites can't be replaced in the lower part of the gut, so vitamin and mineral supplements are for LIFE.
The DS combines aspects of both the VSG and the RNY. Like the VSG, about 90% of the stomach is completely removed, and like in the RNY, there's an intestinal bypass. However, where the RNY bypasses about 100-150 cm, the DS bypasses a great deal more. (For example, my small intestine measured 690 cm. Had had an RNY, been bypassed for 150 cm, I'd have a 'common channel' of 540 cm. With my DS, I have a common channel of 90 cm.)
This much more dramatic bypass means the body simply cannot grow enough extra villi to go back to absorbing normally.So DSers have lifetime malabsorption of calories---about 50% of protein, 40% of complex carbs, and 80% of fats. This is a major factor in making maintaining weight loss pretty easy, at least for me.
But what about vitamins and minerals, you say? What about malnutrition?
Remember what I said about the receptor sites from most vitamins and minerals being located in the duodenum and upper part of the jejunum? The DS actually leaves part of the duodenum in the alimentary limb, and preserves the lower portion of the stomach. This makes the absorption of iron and B12 better than in the RNY.
Yes, the average DSer takes more/different vitamins than the average RNYer. DSers take a LOT more fat-soluble vites than RNYers, because we're absorbing so very little fat. Other vitamins and minerals---well, every WLS patient needs to base what she takes on her own, individual lab results. Some RNYers take more than some DSers, and some don't.
Malnutrition is possible after ANY form of WLS, even the LapBand. Interestingly, a significant per centage of obese people are malnourished BEFORE they have WLS.
Long term, the form of WLS with the very best stats for maintained weight loss is the Duodenal Switch. This is true for patients of any size, but especially so for those of us with a BMI greater than 50. The DS also has the best stats for resolving or preventing diabetes and high cholesterol.
What you really need to figure out is whether your metabolism is just too darned efficient or not. Some of us are born with a 'thrifty' gene that allows our metabolism to 'save' more calories than average people do, and the more we diet, the thriftier our metabolism gets. (Yes, that does indeed suck.)
The VSG causes some minor changes in our metabolism. Recent studies have made this very clear. What's not yet very clear is how lasting those changes are. These changes are most likely due to the removal of about 90% of the stomach.
The RNY causes greater metabolic changes than does the VSG, but not exactly the same ones. In the RNY, none of the stomach is removed, it's just bypassed for food. It's still in there, making digestive enzymes and, occasionally, developing ulcers or cancer. And it can't be 'scoped. This is the primary reason that RNYers are advised to avoid NSAIDs. The secondary reason is the bypassing of the pylorus, replacing it with a stoma which is always open. This is a weak point for the development of what's called marginal ulcers.
The RNY causes metabolic change by bypassing a small portion of the upper end of the small intestine, usually about 100-150 cms. This is all of the duodenum and some of the jejunum. This causes temporary malabsorption of some calories (on average, about 30% of fats, and a smaller per centage of the protein and complex carbs). Unfortunately, the body's very adaptable, and grows extra villi inside the still-fully-functional portion of the intestine, and for most people that means they're back to absorbing protein and carbs pretty normally by 18-24 months post-op. (Some fat malabsorption is permanent, and this means that many RNYers need to supplement the fat-soluble vitamins A, D, E, and K.)
This portion of the small intestine is also where most vitamins and minerals have most of their receptor sites. Those sites can't be replaced in the lower part of the gut, so vitamin and mineral supplements are for LIFE.
The DS combines aspects of both the VSG and the RNY. Like the VSG, about 90% of the stomach is completely removed, and like in the RNY, there's an intestinal bypass. However, where the RNY bypasses about 100-150 cm, the DS bypasses a great deal more. (For example, my small intestine measured 690 cm. Had had an RNY, been bypassed for 150 cm, I'd have a 'common channel' of 540 cm. With my DS, I have a common channel of 90 cm.)
This much more dramatic bypass means the body simply cannot grow enough extra villi to go back to absorbing normally.So DSers have lifetime malabsorption of calories---about 50% of protein, 40% of complex carbs, and 80% of fats. This is a major factor in making maintaining weight loss pretty easy, at least for me.
But what about vitamins and minerals, you say? What about malnutrition?
Remember what I said about the receptor sites from most vitamins and minerals being located in the duodenum and upper part of the jejunum? The DS actually leaves part of the duodenum in the alimentary limb, and preserves the lower portion of the stomach. This makes the absorption of iron and B12 better than in the RNY.
Yes, the average DSer takes more/different vitamins than the average RNYer. DSers take a LOT more fat-soluble vites than RNYers, because we're absorbing so very little fat. Other vitamins and minerals---well, every WLS patient needs to base what she takes on her own, individual lab results. Some RNYers take more than some DSers, and some don't.
Malnutrition is possible after ANY form of WLS, even the LapBand. Interestingly, a significant per centage of obese people are malnourished BEFORE they have WLS.
Any idea when I should expect the ulcers and cancer - I'd like to put it on my calendar so I know 
Proud Feminist, Atheist, LGBT friend, and Democratic Socialist
...perfect response kim....I love how so many like to diss RNY.....
So in this same vein as "cancers and ulcers".....I will add tongue in cheek....Ds'ers poop their pants and VSG'ers choke on reflux acid.
All of the surgeries have pluses and minuses....none is perfect despite what you may read. The key is to inform yourself of the details of each surgery and decide for yourself what works for you physically and mentally.
...perfect response kim....I love how so many like to diss RNY.....
So in this same vein as "cancers and ulcers".....I will add tongue in cheek....Ds'ers poop their pants and VSG'ers choke on reflux acid.
All of the surgeries have pluses and minuses....none is perfect despite what you may read. The key is to inform yourself of the details of each surgery and decide for yourself what works for you physically and mentally.
I love this.
As you said, each surgery has different post op challenges. It's up to you to decide which one best suits your lifestyle (I don't like poopy pants and smelling gas so the DS was no bueno for me)
"Oderint Dum Metuant" Discover the joys of the Five Day Meat Test!
Height: 5'-7" HW: 449 SW: 392 GW: 179 CW: 220
...perfect response kim....I love how so many like to diss RNY.....
So in this same vein as "cancers and ulcers".....I will add tongue in cheek....Ds'ers poop their pants and VSG'ers choke on reflux acid.
All of the surgeries have pluses and minuses....none is perfect despite what you may read. The key is to inform yourself of the details of each surgery and decide for yourself what works for you physically and mentally.
Now wait just a minute---I did not say that all RNYers would develop ulcers or get cancer, nor did I say those things would not happen with a different surgery type. I was not dissing the RNY, I was attempting to point out some of the differences between the surgery types.
Let me state for the record that I do not think everyone should choose the DS. In fact, I know there are people who absolutely should NOT get a DS. But it's not up to me to decide---it should be up to them, and them alone. That means that everyone considering having any sort of WLS should know about all forms. The DS is the "best-kept secret" in bariatrics, and that's a shame. Have you visited the Revision board lately? Far more people than necessary wind up needing a revision because they didn't fully understand all their options before they made their choice.
Batwingsman · 1 replies · 1624 views
