Protein Question/How many grams used???

It adapts, but it never really gets back to 100%.  Depending on the site of the anastamosis (where the two sections of the gut were connected together) there are nutrients that will never get close to their pre-surgery level of absorption - but it does improve.   In the gut, the cells that are closest to each other are most able to take on the other's job - but when you are looking at nutrients that are absorbed in the proximal duodenum (that's the first part of the intestine, right after the stomach) it is unlikely that you are going to get good adaptation way down in the distal jejenum (the last part of the middle section of the small intestine, where many of RNY patients have their anastamosis).   The nutrients that are proving to be poorly absorbed even years out include calcium, iron, B1 - thiamine, and Vit A.  There are cases now in the literature of thiamine deficiency in addition to many cases of calcium deficiency - the suggested cause is not continuing the supplements long-term post-op.  If you are curious about thiamine deficiency, look up the disease called "Wernicke's encephalopathy"  it is usually associated with severe alcoholism - now it is also being associated with post-op gastric bypass surgery. That's why it's important to keep taking your supplements for the rest of your life. regards, Danielle Halewijn RD Director of Nutrition eNutritioncare.com

What's even scarier....is that someone like me, who never ever misses vitamins and calcium....have a low A level...way too high K level and a ferratin count of 9!  Infusions in my future, and soon so says my PCP.   So, until then....I am doubling my daily vitamin for A (changing to a higher quality daily).....not sure about the K....got a script for high potent liquid iron......and still gagging down powdered beef liver....... Wish me luck!

So glad I found a post on the main board directing me to this info. Awesome! On adaptation, there is another aspect of this that is coming to light that has to do with extreme persistent post-op hypoglycemia - recently defined as Noninsulinoma Pancreatagenous Hypoglycemia Syndrom (NIPHS). The theory goes that because of the location in the intestine where food gets dumped straight from the stomach after RNY, at about TWO YEARS OUT, the cells in that area of the gut have ramped up production of certain things (such as C-peptides) to deal with the undigested glucose. Over time, this works its way back to the pancreas where the islet cells become supersized and become overactive in producing insulin to keep up with the "perceived need" from the "distress" signals that come from that part of the gut that's now getting all the undigested glucose - hence the severe blood sugar crashes. Unfortunately, the treatment for this currently is removal of most of the pancreas! The good news is that once they unravel the mystery of how this works, the secrets to controlling diabetes will most likely be revealed. I've had to learn allll about this because I have been having severe, persistent post-meal blood sugar drops (into the 30's), and my primary care doc has referred me to an endocrinologist for evaluation for NIPHS. Most of the work on this has come from the Mayo Clinic - if anybody reading this wants more info, links to the studies are in my profile. Thanks for busting the 30g/meal myth!

Danielle, I copied your message above (the one that posted at 9:46 about the 25-30 grams of protein per serving being a myth) and sent it in an email with my own questions to my bariatric surgeon and his dietitian.  They both liked what you wrote.  In fact, here's my surgeon's comments:

Lea,

I love that dietitian, there are so few that truly have the common sense to question the norms that have been preached for years.  She is absolutely correct.  Protein absorption can be limited to a degree because we only have so many receptors in the intestine for transport but the 20-30g limit is a crock.  Our old dietitian really preached that but as of the last two years we have adopted the common sense approach similar to what that dietitian online was talking about.  Tell her Kudos from me.



Daniel L. Stickler, M.D.

President Medabolix, Inc.

SO, there you have it!  I've been very fortunate in that my surgeon and the RD both are usually very up to speed on modern research in the areas that we need addressed as WLS patients.  They both look for new/current info instead of resting on their laurels with older, perhaps less valid information.  And, they both LIVE the lifestyle that they promote, which makes it easier to follow said lifestyle suggestions! Lea

Thank you so much for sharing that! You made my day! -Danielle

(If anyone besides me had trouble reading the entire post listed by Lea:  I copied and pasted it into my Word program and then could read it!  It is worth the time!) L