New DS Patient

Hello everyone,

I am just shy of a week out of DS surgery--I had my surgery done last Thursday, and went home Friday afternoon. I had a sleeve in 2013, but could not maintain the loss I had and knew I needed to do something to ensure that I could. I also wanted resolution of my diabetes, which seems to be well on its way to happening! My sleeve was also reshaped as it was cut as an hourglass in my original surgery, so my surgeon shaped it to be more banana-like. This will give me more restriction, thankfully so I am hopeful that I can hit my goal weight of 170 pounds.

I have a couple of questions for the crowd:

• The spasms in my GI tract are vicious...when do they stop? I don't remember this happening with my sleeve but of course that was 10 years ago. I was prescribed Robaxin for these and take it when needed.
• I am wondering what my protein, fat and carb goals should be. My CC was constructed to be 200 cm long so shorter than a SADI but longer than a Hess DS. Right now since I am still on full liquids I am concentrating on hydration and protein.

Thanks in advance for your insight and advice. I hope that I can learn a lot from the group's expertise here.

Hello,

Congratulations on your revision. I hope your recovery is smooth!

A caveat - I'm still in my losing phase and haven't hit maintenance yet, so my experience is in progress and I'm still learning what works for me.

Per your first point, I don't think this happened for me. I remember my intestines reactivating the evening I had surgery and had some rumbling. I do have contracting and bowel issues depending on my diet, speed I eat, etc. I occasionally have what feels like tightness in my sleeve, especially when I eat too fast. Nothing I'd describe as spasms, though. Did you have one connection done, or two? That could make a difference. And GI tract is everything...is it everything spasming? Sounds like your doctors are aware if you have a prescription, so that's good!

For your second question, my clinic says 80-100 grams of protein per day. My common channel is 300 cm and I've always had borderline protein numbers. I'm on the edge of low now consuming 90g per day but I was also low before surgery. My clinic didn't give macros for fat outside of less than 3g per serving except for beef (up to 10). They are believers in low fat to prevent bowel issues from malabsorption. I personally aim for moderate fats to boost vitamin absorption but am on low fat since I just had my gallbladder out. Carbs especially are the big variable and it's how I'm told I'll control my weight once I hit maintenance. We got lists of non-starchy carbs to work towards in soft foods for vegetable intake (2 weeks to 3 months). At six months, purely due to how I've been losing, my clinic reintroduced 15g of starchy carbs per meal from a list. Basically, it's super low, non-starchy carbs until you get close to maintenance for my clinic. Amounts were by volume/weight so you don't overeat. I also don't have calorie goals at the moment.

All of that rambling to say, your needs and experiences may differ but it can help to have some data points. Protein is the main focus, for sure. That has literall been the first and primaryvmacro focus. I've also learned that everyone's plans from their clinics can be highly variable, so hopefully yours provided some guiderails!

Best of luck to you!

Thanks so much for your reply! I had two connections done since I had a traditional DS and not a SADI. The only thing that differs is the length of my common channel--it's 200 cm as opposed to the 100-150 that most traditional DSs are. My doc does a standard CC for all his patients and they get great results with that.

I figured that my fat intake should be somewhat moderate but not so low that I can't have normal bowel movements or end up with dry skin and brittle hair. I also want to be able to absorb the ADEK vites since those are the fat solubles. I guess when I see my doc and dietician next week I can ask them what that looks like. I figured my protein intake would be anywhere from 100-120 grams a day once I'm able to work up to that. Because of the spasming in my GI tract right now, getting 60 is a challenge.

I appreciate you sharing your experience so far--at this stage, information from folks who have walked the walk is helpful! Thanks again.

I will say that after 3.5 months on a very low fat diet, I did have all the things you mentioned. My skin and hair were dry, dry, dry. I was taking Miralax every day and had several malabsorptive issues with my fat soluble vitamins. So, I get it. Moderate fat had been working better for everything until my gallbladder went. My vitamin numbers were largely back in range. It did make a difference.

The DS (and SADI) are the only weight loss surgeries that require higher fat. I will assume you had traditional DS for explanation purposes, ok? In order for our body to "use" or metabolize fat, that fat must come in contact with Bile, which is produced by our body. If there is no Bile present, the fat is not utilized as energy. So no absorption of the fat and no absorption of the calories from fat. When the surgeon "rearranges" our intestines, it is done in a manner that rerouted Bile around the majority of the intestinal track (small intestine). In a DS, that Bile is reintroduced to the small intestine for only about 100 to 150 cm at the end of the process. Hence, the body doesn't absorb it until then. For a traditional DS, scientific studies documented that a DSer will absorb only 2 in 10 grams of fat. So if I, for example, eat 100 grams of fat in a day, my body will utilize only about 20. (And will excrete the 80 unused grams in my stool). 20 grams of fat is not healthy. The body needs about 30-35, minimum. For brain function and skin and hair and bowel health. So when a Medical professional touts low-fat to a DSer, he/she is actually demonstrating that they don't understand the implication of malabsorption. And in my opinion, actually doing harm to their patient. We as DSers actually need to eat a high fat diet to get that minimum daily absorption level for our body to function properly. Tell me if that makes sense to you. Fats are not the enemy | Bariatric Facts

Many dieticians are so invested in the whole low fat thing that they can see nothing else. If they tell you to eat low fat everything, they are probably wrong. A more sensible approach is to start by simply not avoiding fat and see how you do. Carbs are what you need to avoid as much as possible. The only good carb is the carb you don't eat. Once you hit goal -10% you can experiment and find out what you can tolerate without gaining. And I said goal -10% because almost everyone has at least a little bounce back.

Some of us eat a lot of fruit and other sugars. I can't. I can count my fruit intake in bites per year. Maybe you will be able to and maybe not. First and foremost, lose the weight while it is RELATIVELY easy. Lose the weight learn what works for you. Yes you can lose weight any time. But your easiest time is right now. Down the road weight loss looks more and more like dieting. And I still diet.

Protein. Your labs will tell the tale. Some people need a LOT and others don't need that much. Just for example, I am fine doing 80-100gr protein per day. And my CC is 75. Yours is much longer.

You will find out what works over time. But you have to remain flexible and willing to change. Because I can pretty much guarantee what works for you today won't be the same as what is working for you 20 years from now!

Malabsorbtion is why we take all those supplements. If they have you on bariatric vitamins and your numbers are bad, be aware that those are not enough for most DSers. Surgeons are cutters. If you buy supplements from your surgeon it is just another revenue stream. Just because your surgeon sells them doesn't mean they meet your needs. You need dry vitamins only, pills or capsules with powder in them. Don't buy gelcaps because most of them are the supplement dissolved in oil(fat).

Thanks for your reply--from the guidance I'm seeing in the post-op instructions from my doc's office, it's not low-fat everything thank goodness! But I did know going in there was no way I could be completely low fat anyway due to the fat-soluble vitamins needing something to dissolve in, plus I want to keep my skin and hair in good condition. I also want my bowels to function properly and don't want constipation.

They haven't counseled me on vitamins just yet but at my two-week appointment this week they indicated that's when I'd learn about what vitamins to take. I have a bariatric all-in-one vitamin pill with iron in it that I took for a few months pre-op but I don't know if it will be enough post-op. I already take a 50,000U vitamin D capsule (prescribed by my PCP) so I figure I am good there. I hadn't planned on buying any supplements from my doc's office because I know there are plenty out there that will work just as well. Right now I'm taking a sublingual B12, and a B1 tablet (doc's office recommended immediately post-op).

I'm just a little over a week out and have tried to get between 60-70 grams of protein each day and so far have been pretty good at it. I've been pretty good at hitting both protein and fluid goals the past few days so forward progress is good progress in my view. I figure that my protein goal will be between 100-120 g a day but I think you're right--maybe I should see what my next labs say. As of surgery, my protein was at 6.8 g/dL so we will see what it is in May when I have my 3-month labs run.

Thanks for the tip about gelcaps--I remember reading that those were a no-no but couldn't remember why. I appreciate your advice and counsel!

For me, I still see protein and fat as free food. If I am hungry, that is what I eat. You won't malabsorb as much as I do so moderate is probably the way to go. And that doesn't mean I eat sticks of butter. I just don't avoid fat and eat full fat everything.

Do some reading about fat soluble vitamins. You should avoid taking them with fat if you can. Learn about how they are metabolized. Has nothing to do with fat, has everything to do with the receptors in your gut. Fat soluble vites are stored in fat and your body will always have enough fat to do that unless your BMI is extremely underweight. You will absorb less of everything you ingest with fat. Fat decreases your transit time(how long it takes for food to go from your mouth to the toilet).

For now just take the pills and don't worry too much. Let your labs tell the tale. Best of luck to you!

Ahh thank you for this information--seems I had a BIG misconception! I appreciate you taking the time to help me get on the right track.

Congrats on the surgery. I'm male, 62 yrs old, had the SADi in 2014 (300cm cc). I have mostly similar experiences to HESS DS patients except for carbs. It seems that everyone has a unique experience, and you'll only be able to answer your questions based on trial and error over several years.

My experience and those I've read here don't generally include spasms post-surgery. It doesn't seem like a big deal but your dr should offer some insight. Regarding protein, fat, and vitamins you should generally follow guidelines for the first few months and then go by your own experience and adjust annually based on lab results and also monitor based on what you see on the scale. Many people cling to their Dr. and Nutritionist after surgery but in reality, they become irrelevant very quickly. You're better off finding a good support group and finding a PCP that understands annual lab results.

My suggestions based solely on my own experience: 1) Eat heavy protein, 2) Fat Full Everything 3) Eat unlimited loads of fruits and Veggies.

I eat 20 to 30 lbs of fruit every week, 100 to 150 grams of protein daily, ice cream and avocadoes for fat, and every morning starts with a banana, chobanni strawberry greek yogurt, and oatmeal. I eat a lot of carbs (chocolate) but I get daily exercise now that I can. I also weigh myself daily, track steps on my iPhone and occasionally track what I eat to confirm nutritional content. My weight has been very stable over the past 5 years, and I'm very aware when things change even a little.