Nutrition, Absorption and Weight Gain

Hello,

I had an Open RNY gastric bypass in 2002. The Bypass failed and resulted in several surgeries immediately after the intial surgery including bowel obstruction surgery. I almost died, was hospitalized for 3 months, in then sent home with open wound infections which were treated for 6 months. After the corrective surgeries, he came in and said, I fixed you, but you arent going to lose anymore weight. I had lost about 60 lbs during those hospital months from not being able to eat. I did go on to lose another 40 for a total weight loss of 100 lbs.

Fast forward to 2013. I have gained all of the weight I have lost back and suffering from severe GERD and other gastro problems due to the intestinal placement from the original surgeon. At that time a revisional gastric bypass surgery was done. It stopped the GERD, but I only lost 19 pounds. I did stick to protocol. However, I never had the full feeling.

Today, I weigh 350 lbs. I am a snacker, I rarely eat a big meal. My body rejects things that are too packed into the pouch and certain foods like raw vegetables if eaten at a certain time will come back up. My body doesnt absorb medication as it should, if I take medicine it could most likely not work, but it will slowly absorb and interact with another medication that I take before or after that one, causing problems such as insomnia.

I dont have insurance that is going to approve anything getting fixed. I even considered band over bypass, but I have medicaid due to a divorce and losing my health insurance, there is not coverage in Florida for any bypass surgeries.

Next step is finding someone who understands gastric bypass patients needs nutrionally and physically, understands absorption problems and can help me lose weight. What dr. would I contact to do that. My pcp hasnt a clue and if I call a bariatric dr. they only consider surgical options.

I would be so very greatful for any help someone, ANYONE, could give. I have tried eating certain calories, low carb, high carb, all of it and my body just doesnt understand any of it. Im continuing to gain weight.

Thanks

Have you considered totally starting over? It sounds like you had been relying on your pouch to prevent you from over-eating but it won't. It can help but most of the work after the first year out seems to require real focus on the details.

Maybe it's time for going back to the basics, cutting out all carbonated beverages, alcohol, coffee, smoking, and sugary drinks. Pick a start date and purge your house of unhealthy food. See if social services will send a nutritionist to your house to look through your food and help you learn how to read labels and make better choices. If you have kids and a significant other in the home, trust me, they will be better off for this switch! There's no downside to good nutrition :)

Something like this:

Month 1- Optifast pre-surgery diet

Month 2 - Walk every day, every hour, for at least five minutes. Week 1 clear liquids, 1/4 cup, every fifteen minutes - sf only no carbonation, sf jello. Week 2 Portions less than half a cup, all non-clear liquids must be spaced thirty minutes from clear liquids (so an hour total) adding items like sf Protein drinks, sf yogurt, low fat cottage cheese. This week you need to start meeting your minimal requirement of 70g protein so you'll still need Whey Isolate protein drinks or powder... Week 3& 4 increase your portion sizes to 1/2 cup and add in pureed foods like low calorie creamed soup, canned tuna, finely ground lean meat, mashed cauliflower...

Month two - You now can start back on "real" food, but each day you have to reach your 80 g of protein and you still can't have any fatty foods or anything with added sugar. Track every bite that goes in your mouth (like you did originally) logging it with MFP or something like it. Introduce physical exercise, like walking 4000 to 6000 steps a day and lifting weights (look into chair exercise videos!) Keep total calories under 1100 ish

Month three - twelve - Keep at the protein first, ultra low calories, no sugar no fried food, no carbonation, no alcohol. Continue to increase your exercise adding 1000 steps each month until you hit 10,000/day and keep lifting weights or other resistance work at least 3 days a week.

The good news is that that same malabsorption that is keeping medications from working will truly help you melt pounds off once you get the food reset!

Amazing!! Thank you so much. I will definitely do this. Thank you. I will absolutely do this. What does Month 1 consist of again, I am not sure about what Opti-Fast is, just shakes? Thanks again!

I think it's two Optifast "shakes" and one low calorie, high protein, meal. If they don't have Optifast those Slim-Fast shakes work the same way :)

Going back on the pre-op diet and repeating the initial stages of post-op has been proved over and over and over and over again to be an exercise in failure. The poster above is PRE-OP and has no actual experience either losing post surgery and more importantly maintaining post surgery.

DENSE solid proteins are the golden key --- definitely NOT doing a liquid diet.

Plus - if I remember that correctly - the pre-op opti-fast drinks were full of sugar, and only 15 gr of proteins per drink. I would die today if i try to drink that. and I would be starving 30 min after one of those.

I can't eat most raw veggies. But I can eat dense proteins, cooked non starchy veggies with some good fat added. 4 meals like that a day keeps me full and my calories relatively low.

Yours is a special case having been revised from the original design. The gastric bypass is a procedure that includes a degree of malabsorption, so it should be expected that you were to never absorb nutrients or meds the same again. There isn't a magical formula, but you tweak according to what labs tell you. What's going to help you seeing any other doc is to have copy of your operative report so they can see exactly what was done to you.

It sounds like you've had quite the time of it. You really need to care more about you and your health. Go back to the basics. I regained to over 300 lbs. Finally decided it's time to get off my fat butt and do something about it. Jan 3rd started back on track 4-5 protein shakes (low carb/low sugar under 150 calories each) and 1 small high protein meal. Then because I really like to be able to eat sometimes, I switched over to 2-3 shakes and 2 small meals. I have dropped 60 lbs in 90 days. I keep calories under 1000, carbs under 50 and get 80-100 grams of protein a day.

I also workout 3-4 times a week and just walk the other days.

You can do it!!!

Have you been tested for an auto immune disorder?

Alot of what you talk about acts like your body over reacts. I just got DX with mast cell activation syndrome which is autoimmune and had I had any surgery other than the DS I would have gained it all back (the permament fat malabsorption saved my life but also brought my disorder raging to the surface). It took my body crashing out (read anaphyleptic shock) at the lowest weight I had ever been to get to this point. My labs are fantastic, Im in perfect health by all standards yet im not. Certain foods at certain times cause major issues. I cant sit and have a meal, if I do it takes me over an hour to finish or just make me sick from too much food, Im better off picking through the day. I have to take H1 and H2 receptor blockers so my body does not "freak out" from being bombarded with histamines (fat cells are great for storing them, but with low body fat and a fat malabsorption it has no where to go exept wreak havoc on my whole body). So it causes inflammation of my fat cells (which makes dexa scans think I have a metric ton of fat on me when its not).

But its also why all allergy meds sped me up instead of make me tired, it gave my body a break. Its been life long and why I made it to 400lbs, didnt matter that I was the picture of health other than my weight. No diet helps even now 11+ years post surgery I just have to be smart about my eating.

Heck good or bad stresses even cause me problems. Luckily I guess is that it cycles and doesnt always cause major problems.

What specialty of Dr will order these tests?? Please. Did you see an endocrinologist or other type Dr?? Have you tried the auto immune food protocols like Paleo or Hashimoto??