malabsorption

A question came up at work today. Will we always malabsorb our food (to a certain extent) or will we eventually absorb ALL the calories we eat?  I wasn't sure so I said I would ask the experts. Rhonda

That's a good question, and one I don't know the full answer to.  I do have a theory:     I believe that our bodies adapt; and I believe the fact that the further out we get and can eat foods that we could not immediately post-op, is proof that our bodies adapt, at least to a certain extent.   That's my theory anyway.  Now, how much every individual malabsorbs, and how much each individual's body adapts, I don't know .  Honestly, I'm not sure if there's a way for a doctor to test that or to really know for sure.   If there was, I would like to know and see about getting tested - just for my own knowledge.  I think when they say RNYers malabsorb 50% and DSers 80% those are approximate figures; because individuals may malabsorb more or less depending on the exact length bypassed, their individual bodies and perhaps other factors (that I'm not aware of) that come into play.  I think the figures they gives are approximates - not absolutes. 

Malabsorb WHAT, specifically? Calories? I don't know that calories would be an accurate measurement. We malabsorb fats/oils forever, to a degree. And certain nutrients will never be gotten from food again. Sugar will always absorb IN THE MOUTH before it ever even hits the changed plumbing.

If you force your body to try to compensate, you'll be able to eat less and less food to hold your wt loss, but you'll stil not get certain nutrients from food in any reliable fashion.

You really do not WANT to turn back into normal or your surgery was sort of a waste of scar(s), right?

I agree Michelle!  Can you clarify the statement " if you force your body to compensate you'll be able to eat less and less food to hold your wt loss"? Since I am in that stage that is where I am working on and learning about. Thanks! Merry Christmas blessings, Tami

Hypertrophy. Opposite of atrophy. a-trophy is without growth, so hyper-trophy is too danged MUCH growth. LOL

I think I wrote something on it awhile back........

This is my amateur explanation:

Leaving out the bands of all kinds (no offense, Brenda), the rest of us have
a common channel, be we RNY, DS, BPD (no DS) or MGB. Whatever it is in
length is what it WAS day of surgery. It doesn't last.

The intestine was designed to absorb & transport food. We agree? OK, and it
has vilii in it, tiny hairs or fingers that do the work, help the
peristalsis along, suck the nutrition out of the food. That is, ONCE the
food has been made digestible by passing through the lower stomach and
duodenum. The DS people have pylorus, and some bit of digestion, but the
rest of us don't have that.

So, we've all lost the basic 8 (nutritional elements) in the lower stomach &
missing duodenum. Then would come the intestine. And while we're all
configured a little differently NOW, the original equipment had the jejunum
(first 12" or so) doing most of the absorption of those basic 8 elements.
Hence the need for supplementation of those 8, plus whatever else your body
requests via nice black & white lab work (no guessing required).

But for these procedures, in essence, the food takes the high road and the
digestive ****tail takes the low road and where they finally meet is the
common channel, where all elements mingle together. Proximals have way more
common channel, so more mingling time. Distals have way less common channel,
where the food & gastric juices get a handshake and move on out.

We ALL absorb sugar, 100%, except for some of us, who absorb it at about
150%, lips to hips, no digestion required. Or in my case, rub it on my arm
and watch me plump up.

The common channel is now doing the job that the entire intestine used to
do, as well as part of what the lower stomach + duodenum once did. It is not
built to do it well. As we know, the body will do EVERYTHING it can to
normalize. Everything. So, the common channel grows more vilii (hairs) AND
thickens AND elongates, in order to do the triple job we're asking it to do.
We all know the pouch stretches, and we assume it's from eating larger
volume, but ALSO, it would do this on its own, because it is trying to
normalize.

If we are malnourished (not enough supplementation, too pukey to get it in,
bad choices-whatever), it will happen to a greater extent. My doc keeps
reminding me this will happen, but I keep saying that my common channel is
never going to KNOW it is missing anything, because I am burying it in
nutrition! LOL!

So, part of the 2 year/3 year wall for ALL of us, is that body trying to
normalize. The other contributing factors are, of course, getting sloppy
about supplementation, water, sugars, volume, grazing--all that stuff. But
the underlying thing that befuddles us is that the stuff we "usta be able to
get away with", well, now we pay the piper and are wondering why.

Hypertrophy (getting over-compensated in the common channel) is one reason
that we have to work a little harder down the road.

It's so clear in my head, so please tell me if I was unable to spit it out
so it makes sense, 'K?

*****

OK, then I also found this other one:

Intestinal Motility after Massive Small Bowel Resection in Conscious Canines: Comparison of Acute and Chronic Phases.
Journal of Pediatric Gastroenterology & Nutrition. 23(3):217-223, October 1996.
Uchiyama, Masanori; Iwafuchi, Makoto; Matsuda, Yukio; Naitoh, Masafumi; Yagi, Minoru; Ohtani, Satoshi
Abstract:
Summary: To evaluate intestinal function after 80% massive distal small bowel resection (MSBR), we continuously monitored interdigestive and postprandial bowel motility using bipolar electrodes and/or contractile strain gauge force transducers in conscious beagle dogs before and at 2-4 weeks (acute postoperative phase; acute phase) and 8-13 months (chronic postoperative phase; chronic phase) after the surgery. Fasting duodenal migrating myoelectric (or motor) complexes (MMC****urred at longer intervals in the acute phase after 80% MSBR than in control beagles. Intervals between duodenal MMC in the chronic phase were similar to those found in control beagles. MMC arising from the duodenum were often interrupted before the jejunum above the anastomosis in the acute phase, and a slight recovery of propagation frequency to the jejunum above the anastomosis was observed in the chronic phase. However, duodenal MMC did not migrate smoothly to the terminal ileum in both groups. In the acute phase, the velocity of duodenal MMC propagation was slowed in every intestinal segment, including the duodenum and the jejunum above the anastomosis, and had not recovered even long after the operation. The duration of the postprandial period without duodenal MMC was prolonged significantly in the acute phase postoperatively. Although it shortened in the chronic phase, it still remained significantly longer than in controls. These findings suggest that changes in gut motility after MSBR tend to compensate for the shorter intestine and maintain small bowel absorption early postoperatively. However, these compensatory changes decrease over the long term, and their adaptive contributions to increased intestinal absorption may decrease as well.

(C) Lippincott-Raven Publishers

http://www.jpgn.org/pt/re/jpgn/abstract.00005176-199610000-00003.htm;jsessionid=CcyeeGtlcxoaKxLG12Q0sbyQYY7eC7EAX4skNe51j70t5HFjSjX4!357004508!-949856031!9001!-1



There. That'll keep you off the street for awhile! LOL

Hi Michelle, I suffered a huge disappointment today and could use some advice. I was scheduled for a tummy tuck / breast reduction, but they cancelled my procedures, due to low blood hemoglobin. I've been taking two ferrous gluconate per day since October, now they have upped me to four a day. Is there a form of iron supplementation for gastric bypass patients that is preferred? I thought I was doing everything right, but my bloodwork is saying different. I really need the plastics, but they won't do it unless I can get my counts up. Thanks Karen G

These were 18mg or 29mg each? I don't see good results with any of the ferrous family, actually. We start our proximal RNY's on either 150mg or 300mg (doc does the 300, I do the 150) of polysaccharride or Tender Iron taken with vit C, not with eggs, dairy, caffeine, whole grains or any other vites, minerals or meds. Alone together for at least an hour.

If you were mine here, I'd start you on 1 poly + 6 Tender + a vit C once/day, test in 30 days, but test the actual iron & ferritin. The H&H don't mean a thing to me about the status of your actual iron.

I'm guessing you're also not taking 2000mg calcium citrate and 10,000 IU or more of dry form vit D?

Thanks so very much Michelle. I just checked my iron and it is 300 mg of Ferrous Gluconate. I was taking two a day and they just increased my dose to four a day. I take the iron first thing in the morning and then wait one hour before I have my coffee and breakfast. I take two multivitamins and 3 x 650 mg calciums, but I space these out later in the day. One multi & one calcium at noon time, another dose at dinner time.... then a final calcium before bed. Until recently, my bloodwork was fine. Weird thing is, I have none of the classic side effects of low iron. I have lots of energy and am exercising regularly. I've been working long hours at the office and thought maybe it was related to that, but my doc is worried it could be something more serious, so I have to go through some tests in January, to rule out the serious possibilities. I am still hoping to have my plastics. I waited too long to give up. I'm going to use this opportunity to try and lose a few more pounds before the surgery. I am going to ask our pharmacist about the poly and the tender iron products. These are not familiar to me and perhaps not available in Canada. Certainly worth checking out. Thanks again, Karen G

So, the fe gluc = 65mg each, so a total of 260 or something, which is good, taken with vitC. But I have no reason to believe that any of the ferrous types work for us. You might find the poly, but I can guarantee you won't find the Tender. LOL

the calcium, is TWO = 650? Double check. It's calcium citrate, right? But not any extra A, D, E, zinc? And of course, you are taking sublingual B12, yes?

Iron is malabsorbed, so age or gender has nothing to do with it.

Iron is a sloooooooooo drop for most ppl, cuz you first you strip the iron, then the ferritin and it can take awhile to feel it. That's why you see anemia at 18-24 months. But the depletion started the day of your WLS. Only a handful of docs in the USA practice preventitive vites, with the rest doing intervention when it's already reached the disease process.

This is great information Michelle.  Thanks, it has cleared alot of fog in my head about maintaining. So, I really have to keep a closer watch as to how much I am eating too? I drink 2 supplements a day, (sometimes 3) but may need to increase.  I try to stick to the protein ,fruit and vege theory and stay away from the white carbs on a regular basis. Don't eat too much fruit, and  never juices. So I need to watch for the hypertrophy which will mean I can eat larger amounts, and if I eat more, i will obviously gain.  Hence the importance of protein supplements and dense protein.  Am I on the right track?  What dry form of vit d do you recommend?  thanks, Tami