1. Is the whole Ghrelin production thing BS? People that get the Sleeve and have the bulk of the stomach removed that causes production of Ghrelin is their appetite really more surpressed then someone who just has Gastric Bypass and or a Lap-Band? My Revision for Gastric Bypass, my surgeon removed that old dormant stomach because he said it still produces the hormone. So I'm hoping!

2. Another thing that I investigated was the "regrowth" of intestinal villi. My PA also said that when the 3 feet of intestine is bypassed, the intestine that's attached to the Stoma DOES NOT grow/regrow any more villi to compensate the bypassed intestine. She said U still have malabsorbtion. Hence the need for lifetime vitamins.

Any input?

Ghrelin is mainly produced by the stomach, but also can be produced by the pancreas, intestines and brain. It seems that the body can make up for losing it in the stomach by increasing production at other sites.

Whether of not villi regrow is debated. But the intestines begin absorbing calories again and malabsorption of calories is gone by year three.

The portion of the intestine that absorbs some vitamins is gone and vitamins have to be taken for life. So you will absorb calories again, but still not absorb enough vitamins from food and will need supplements for life.

I am not sure what to think about ghrelin production, and its relationship to hunger. In addition, there's a lot of contention that the vagus nerve is imperative due to its relationship to hunger. There are a number of people and surgeons who swear that by severing the nerve, you will remove the hunger signal.

I wanted the *magic surgery* that would make losing weight effortless -- and thus, asked my surgeon specifically to cut my vagus nerve. I was getting an RNY, and one of my impetuses for choosing that procedure was that I did NOT want any of my stomach removed -- so that is not something I sought out.

There are people here who swear they no longer feel hunger after WLS. Some of them have had RNY, some VSG and a few are DSers -- I am not sure what is different for them -- but I am envious! I still feel hunger despite having had the vagus nerve severed. Arguably the great majority of us (all surgeries included in this blanket statement) still feel hunger, especially after the honeymoon period.

However, I'd also like to throw this thought out there: the great majority of us did not become obese due to physical hunger. In fact, at the peak of my obesity, I don't think there was ever a time that I went long enough without food to ever actually be hungry. I mean, I could have survived a winter in Alaska on Naked and Afraid without so much as a stomach rumble. Therefore, I would guess what a lot of us perceive as hunger is really more of just a desire to eat. Vets call this head-hunger. Unfortunately, WLS (no matter the type) doesn't change that.

Therefore, I postulate that perhaps one of the key differences between obese people and normies is our perception of hunger?

To your second question, only the caloric malabsorption is temporary; we have to take vitamins for life because the vitamin malabsorption is permanent because only certain portions of the intestine have the ABILITY to absorb certain vitamins. Those with surgically removed intestines also have to take vitamins for life. There is actually a ton of research on this, as it's basically the same as those who have had to have short bowel syndrome adaption, which is very close to what a person who has had an RNY has removed. IN any case, the physiology would be the same. It would be greater for a DSer.

Here's a link to get you started:

http://emedicine.medscape.com/article/193391-overview

I this so much. Particularly the part about our brains...

There's no magical surgery for our brains...

I was recently at a small gathering (at home business sales thing) with another WLS friend. I realized at one point that her and I were the ONLY ones back at the food after the original platefuls everyone had... It kinda really hit me that our brains are so much different than 'normies'... I backed away and stopped eating (and it was all 'good' food... cheeses, veggies, berries).

I have eating issues that don't stem from true hunger... and I still have a hard time swallowing it, but it's called an eating disorder... it sucks.

Well said Kat, well said.

"One of the key differences between obese people and normies is our perception of hunger". I think you've hit the nail on the head!

In addition to the great responses above, ghrelin is NOT the only hormone involved in hunger. So even if all the ghrelin was removed, which it isn't, you could still feel hunger.

Most WLSers, of all surgeries, go for six months to a year without being hungry. It's magical. Take advantage of every minute. Lose every ounce you can as long as you dont care about food. Because the vast majority of us have hunger come back

TRUE STORY: I was several months post, and was having gut pains/sounds I couldn't identify. OH Chat was active, back then. After conversing, back and forth, I truly felt pretty stupid..

My "Gut Pain" was true, physical "hunger pain/stomach growling"...I had probably never been hungry, in all my life...So I didn't recognize the symptoms

My OH peeps didn't let me live that one down for a long, long time...Ever morning it was "Hi, Gina! Have you eaten yet?"

Your best bet for real answers is to use Google and read medical journal research.

Gherlin levels are decreased, even when they do increase over time, they never reach pre-op levels.

The interesting thing in the study that I read is that some people still said they were hungry with low Ghrelin levels while others didn't. Personally I attribute that to stomach acid mimicking hunger and people who are food addicts and can't differentiate between head and physical hunger.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4280419/

There are numerous studies, so if you are really interested it is better to read those than ask people on internet forums.

I'm almost 2 years out from surgery and unless I go over 24 hours without eating, I do not get physically hungry. And yes I have gone 24 hours without eating before by accident, which is why I track religiously. And my stomach works fine I get normal triggers I am full. I just don't get a lot of signals that I am hungry, and the ones I do get are so weak I can ignore them. I can easily drink fluids all day and not eat at all if I get busy with a work project. However this only works if I am at my desk all day. If I am up and active I have to eat or I get faint.

I won't speak on malabsoprtion but almost everyone in Western society needs a daily vitamin anyway, WLS or not. The way our food is grown, shipped and processed lower the nutrients in it. It is basically impossible to get all the vitamins you need from just food.

Plus the reason all WLS patients need vitamins is not just because of bypassed intestines. It is because food does not sit in our smaller stomach as long as other people and it is not as processed by stomach acid (this is why people have foul smelling gas), so the vitamins are also not as broken down by stomach acids. That is the need for supplementation for even sleevers with no bypass.

My anecdotal experience with RNY patients is that their malabsorption of calories does come to and end eventually, their body adjusts and they start to regain because malabsorption is no longer their safety net for bad food choices.

>...almost everyone in Western society needs a daily vitamin anyway...

Science says nope.

"The results of large-scale randomized trials show that, for the majority of the population, there is no overall benefit from taking MVM supplements."