Frustration about information

Hi all, my story is long and complicated but the short version is that I am planning on having the duodenal switch procedure in the next few months. I am very frustrated however because of the conflicting information I am getting on what my diet needs to be after surgery. Not the post-op diet but the full solids, rest of my life diet. It seems to me that the required intake would change drastically based on the chosen path you take. Between LapBand, VGS, Roux N Y and DS there would be a significant difference in diet requirements going forward.

When I watch videos on YouTube by DS patients there is significant discussion on malabsorption rates for the different food types but when I look at the recommended diet in the materials provided to me by my health care provider, the recommended diets are exactly the same for all. (Excluding LapBand, they do not perform that procedure) I can't imagine that eating the same diet as a GS patient after DS surgery would be anything but fatal. Based on the the information I have found on the net I feel like I would be absorbing the equivalent of 500 calories a day.

I can't imagine that to be a healthy lifestyle unless of course I wanted to weigh 50 lbs. I am hoping that I can get some feedback on what I should be planning to eat after surgery once I have made it to the normal diet stage.

thanks in advance

I am assuming you are having a standard DS. 2 anastomosis.

Doctors frequently give everyone the same information, no matter what the surgery. They are lazy. Most of the long term successful DSers have learned how to eat and stay healthy from their peers. Back when I had my surgery a lot of doctors were telling us to take 2 Flintstones every day and we would be fine. Bottom line, surgeons are cutters. They know how to do the operation. They don't actually know much about nutrition or supplementation.

A healthy lifestyle for a DSer does not look like a standard diet. And then, all DSers are not the same either. The results of the DS are a Bell Curve. Some people get to live the dream and eat protein plus whatever for the rest of their lives. Some still have to be careful or they will gain weight. No one can tell you where you will be on the curve. If you are having the DS it's a pretty good bet you already know you are metabolically challenged and diets do not work for you. And if they do the weight loss is not sustainable long term. There is no surgery out there that works better than the DS but it is still work!

I think living with the DS is easy. But in the beginning, it sort of takes over your life. You will move forward and it will become automatic. Protein first will be for the rest of your life. Period. Some people need more than 100gr per day. And sometimes it changes when you are years postop and you lose some of your malabsorbtion. I started at 80gr per day, moved up to 100, and now I am back at around 80. Everything is all about performance over time. You won't get sick and die if you miss a dose now and then or fail to get your protein every day. But you will get sick if you screw up all the time!

After you heal you are in your fast loss phase and that is what you need to do. Lose weight. Every carb you don't eat is a personal victory. You won't have room for much besides protein. You eat protein plus low carb veggies. You can probably fit in your meat plus a couple bites of something like green beans. Breakfast will be eggs with cheese. In the beginning many don't tolerate a lot of fat but keep trying. Butter, cream, and cheese make our standard diet easier to live with. Fat is sort of like free food. Take advantage of it. So, high protein, low carb/sugar, and moderate to high fat. You no longer need to worry about cholesterol either. A lot of us have LOW cholesterol.

After you lose the weight... Go 10% under your goal. Why? Because almost all of us have some regain or Bounceback when we are done with the fast weightloss. So here you sit after losing all your weight plus 10% more for good measure. What now. Eat your protein, low carb veggies, and start adding in a few carbs. Have a piece of fruit or some oatmeal. Weigh every day and if you are over your magic number for 3 days in a row you go back to strict low carb till it's gone. If you are still losing, add in a few more carbs. Have toast with your eggs. It will take some time to figure out how many carbs YOU can eat!

Best of luck to you!

Thank you very much for your quick and detailed response. I will follow your advice.

A couple of observations. Did the diet you got from the Doctor's office really say that this is your diet for the rest of your life or is it the diet they would like you to follow once you are healed enough to be on solid foods? In the early stages they might be quite similar. (Still not an exact match but close)

Not that Surgeons or WLS practices generally are great in the practical terms of living with your DS.

Protein first is a valuable mantra, especially so in the first 12 to 18 months. Meeting protein goals is something that will become 2nd nature after a while because it is your health you are looking out for..

With the DS you will be able to add back foods over time to have more "regular" meals. For me, the meals I have today are much more varied at 7 years out than they were the first 2 years and are much healthier than I ate pre-op.

It's natural to think your surgeon needs to supply you with all he answers. I wanted that first from my surgeon and then as time went on I wanted certainty from the vets. Life is a little more complicated and you have to see what will work best for you.

Of course you would never follow a plan that actually hurts your health by losing too much. Everything needs to be customized as time and cir****tances change.

For instance, I am a lot more active now. It lets me eat more than I could if wasn't and I can see the difference when I don't get to exercise but I know he adjustments I have to make.

SO just a few things on the overall eating changes.

Always get in your protein (and VITAMINS) to stay healthy. Eating protein feeds into the strengths of the changes you will have made to your body.

Never eat low fat again unless there is no alternative or you just like it. You will have plenty of time to figure out how much fat is actually good for you - opinions vary quite a bit. I've never gone out of my way to add fat to my diet but don't avoid it like they sometimes tell you either.

The first 6 months especially, tastes and reactions to food can change dramatically from week to week. There was a period I didn't really care to eat at all and had to schedule my meals to make sure I got my protein ( a fairly short period of time but it worried me at the time ). Also, some tastes change permanently and even though my mind may tell me to have something I used to like as a treat now when I actually have it the taste isn't the same. In my case this was a good thing for things like sweets and chips.

Also, sometimes people start out lactose intolerant. I started that way. It took me a while to figure out that the dry milk my surgeon had in his plan as a protein booster caused me trouble but after a year of lactaid and frozen yogurt that went away. Luckily it wasn't ever so bad I couldn't have cheese. :)

Not sure I really answered your question. Today I don't forbid myself any food but I severely limit the quantities based on how I know my body will react. Things change over time. A slice of birthday cake sent me on a quick trip to the bathroom the first year but now I can have a slice without that worry. I just don't have the urge any more to have more than a slice.

Pete

Thank you for your response. The diet for life I have been given indicates that you should avoid fatty foods. Based on what I have been reading and seeing from those who have undergone this surgery it would appear that isn't necessarily the case. I am a planner and my frustration comes when mixed messages interfere with my planning. I know this may seem somewhat anal but planning helps me feel like I am being proactive, at the same time it helps to relieve stress. Oddly enough I am a stress eater and the biggest cause of stress in my life these days is this surgery along with moderating my eating.

Currently I am running at about 15% carbs, 25% protein and 60% fats. I am a big carb fan so I have replaced my carbs with fat. So it looks like I need to move my fat number way down and get my protein up. My fat mostly comes from salad dressing, mayo and Greek yogurt. Still lots of work to do but I have at least 4 months until surgery so there is still time.

I read the archives here from top to bottom when I was pre-op trying to figure out the best way to deal and put my mind at ease about potential problems so anal reactions are not unknown to me. :)

It's very nerve wracking pre-op when you realize that there are only approximate answers to some questions as opposed to exact plans. I was pretty much emotionally over the top the first couple of months because I wanted someone / anyone to just tell me exactly what to do to succeed.

I eventually came to the conclusion that you pick what seems to you reasonable choices and then modify based on the results. (labs, BM, whatever seems off ). Ask away but don't be put off that people may have different answers for you - just consider what works for different people.

It's not wrong to try and configure your eating habits before the operation but you may find it much easier post-op than you are finding it pre-op. I'm not quite sure why, although I think the radical change in our stomach flora, but my attitude and reaction to food changed radically after surgery. I still had mental "pushes" towards old eating habits but my body just didn't provide the positive feedback anymore.

It may not seem like it but you will get through this. As always it is not knowing that is the hardest and for some of this you have to experience it to really understand.

Pete

After about 12 to 18 months, you'll be able to eat anything you want with a DS, or a SADi DS which is what I had about 5+ years ago. You eat what you want but have an awareness that eating more protein is good, and certain foods may cause gas or bloating. Once every year or so, you'll get some lab work done to see if you need to make any adjustments to your eating habits or vitamin intake.

It's not really a big deal.

Thank you for your response, I will focus on protein first.

The first year after my DS I focused on limiting carbs (carbs turn into sugar and we absorb 100% of sugar). You have to build up your protein - 30 grams of protein by 30-day post-op, 60 grams of protein by 60-days post-op, and 90 grams by 90 days. It's a process. I think I tried to keep my carbs to 20 grams of carbs per day. Drink lots of water (minimum of 64 ounces of water per day).

For me it was all about re-learning how to eat for my new DS. Read labels. Learn about the food you're eating. Learn how your body reacts to food.

I just had my 17 year surgerversary. I'm still exactly at the goal weight I set 17 years ago. I eat what I consider a normal diet, with the exception of more protein. I don't really limit carbs but I have learned what I need to maintain my weight.

I had the lap band for 8 years that thing trashed my esophagus with permanent irreversible damage. My quality of life was in the ****ter. The DS is a god send! Amazing quality of life. I was scared about the malabsorption, especially since my osteoporosis hereditary risk, and that is nothing to sneeze at, but you know what, the DS is amazing. You get used to the pills, I am 10+ years out...I can eat what I want, but I don't , i respect my body too much. I eat like an athlete now, the last 4+ years I have missed one day at the gym, yes I go 7 days a week and eat very clean. I eat a lot less protein than most on here....about 75 grams/day. My lab work including albumin etc are excellent (but I am on the small side) hands down you cant compare DS to other surgeries....well lap band anyway. Dont be afraid of the pills, start building up your defieicncies now...get lab work and work on it before....