Question:
How much??

Hi everyone. Last week I posted a question about fat intake, I was wondering how much was too much. I had a Proximal RNY. Could any other RNY'rs tell me how much they normally take in and on how many calories?? I usually take in 20 grams on 600-700 calorie diet. Thanks!! :) — Kari G. (posted on March 27, 2000)

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March 27, 2000
Hey Kari: I can't imagine your eating much less than you are now. You are certainly in weight loss range with 20 grams and 600-700 calories. I would almost wonder if a few more calories would be helpful. I have heard and do believe that if we eat too little, our bodies will protect all the calories we take in and not let us lose. It doesn't want to starve. If the extra calories were not fat calories, that would be best. Also lots and lots of water and of course exercise will help the metabolism. Good luck. Proximal LAP RNY 9/22/99 - 70 lbs lost.
— Dot W.

March 27, 2000
Diane is correct.. I was taking in 400-500 calories first three months did really well at weight loss..Now for last two weeks I was on a small plateau ..I jump started my weight loss again by upping calorie intake and increasing exercise and water. My normal now will be 600-700 calories a day... 20-25 fat grams is comfortable fat zone to be in. Our bodies have to have some fat to operate on. I have planned my meals for today already. It has a total of 509 calories from food and 100 for protein supplement.. So my total calories is 609.. (176 calories from 16 grams of fat) With 83 grams of total protein. ;-)
— Victoria B.

March 27, 2000
Melanie, I take in about 1000 calories a day, depending on my exercise schedule (I take in less if I am NOT exercising). I figure if I take in less: A. I would feel deprived and B. I would starve myself too much and my body would hold onto my fat. I figure when I exercise, I burn up around 400 calories, leaving about 600 calories intake. With my bypass, part of that 600 isn't absorbed either. I personally believe that low of intake isn't good. While I may not be losing as much as quickly as others who may keep their calorie intake lower, I feel like I am doing what is right FOR ME:) Besides, 39 lbs. in 9 weeks isn't too bad, and it seems like my sagging skin is keeping up with my loss so far! By the way, my fat intake is between 20 and 27 grams for the day with no more thatn 9 grams at a meal. Just my 2 cents.
— M B.

March 27, 2000
Melanie: Good question!!! I sure can handle this forever, remember smaller stomach, trust me that fills it, and the more protein I eat, the less I need mid day snack, however, my surgeon said once his patients meet goal weight they can boost their calorie intake so that they won't loose any more weight than desired. He suggests 1200-2400 calories that depends on the individual to stay at their maintenance weight. (it really depends on your exercise regiment) Personally I don't know how I could get than in, or would I ever want too, but he assures me it will be ok to do that once at goal weight as long as water intake is kept up and exercise. (won't be a problem at 140 lbs) ;-)
— Victoria B.

March 27, 2000
Thanks for sharing your experience with your new anatomy, Ava! I am curious about one thing that I hope you can clarify -- how does the fact that food empties out of your new stomach faster lead to feeling full longer? One would think that it would be the opposite. I know you've put a lot of time and effort into studying the clinical aspects of this surgery, so I appreciate you sharing that knowledge with us. Curiously yours...
— Kim H.

March 27, 2000
Kim: Because it's no different from the feeling with your stomach when you're full.. We just have a smaller stomach gets fuller quicker.. But the full feeling is the same I expect.. If I had to compare it to my pre-op stomach full feeling is exactly the same. I definitely know when to say when. Which is usually after I eat 3-4 ozs of food and that fully satisfies me until next meal. ;-)
— Victoria B.

March 28, 2000
MB - I think you expressed one of the main issues I had with WLS when you said "I figure if I take in less [than about 1000 calories a day] I would feel deprived." That is what concerned me about surgery. Frankly, I enjoy eating! I like the social aspect of it, and I really like the sensory experience... i.e. a juicy lobster tail with drawn butter and lime, grilled Baja style... or a nice slice of prime rib au jus... it's making my mouth water thinking about it. :-) I didn't want to give up eating eating that stuff, or have to take just a bite or two. I would have felt so sad! But the flip side is that it's a sacrifice I would have happily made in order to achieve my weight loss goals. Glad we don't have to do that!
— Kim H.

March 28, 2000
Kim: First you have to realize we (RNY's) get that same mind set satisfaction from a 1/2 of cup of food as you do eating a whole lobster. (actually I prefer just the claw)... We're not missing out on a thing!!!! Since our stomach is smaller our satisfaction in eating food is every much as enjoyable as yours. Same taste, same full filling, same quality of life. I guess it's just something you would have to experience, I can't make you think or feel what we feel. You're very happy with your choice and I'm so very happy for you.. We're sisters in this together for the long haul... Like wise I'm thrilled with my results and I'd do it again in a New York minute. I have no regrets what so ever!!! By the way I weighed 272 this am making 83lbs gone forever..from the hospital weight and 95 lbs gone from July 1999.. I have went from a size 5x to a 20-22.. I have went down from size 56-D bra to a 44-C.. I think I'm in love with my surgeon ...*smile* Just kidding.. WLS Does work..and notice I said WLS that includes your surgery as well.. I'm proud of us..aren't you?
— Victoria B.

March 28, 2000
Vicki -- I think perhaps I didn't express my feelings in my last message very well. You said: "First you have to realize we (RNY's) get that same mind set satisfaction from a 1/2 of cup of food as you do eating a whole lobster." A couple of things I'd like to clarify here: 1) a BPD/DS is an RNY -- just a modified one. So I enjoy all of the benefits of the RNY. What I don't get is effects of a pouch. Second, I cannot eat an entire lobster, but I can eat more than a half of a cup. And what I can eat doesn't always satisfy me intellectually. If something is really, really delicious, I want more! It's the sensory experience that I miss, not the feeling of fullness (obviously we all get that). I know you "pouches" get just as full as we "gastrectomies" do, but on less food. My point to MB was that I really love to eat, and I know that I would feel deprived on less food than I currently eat, because I still feel deprived at times now! Not hungry, just intellectually deprived of the experience of continuing to eat something really delicious. You said: "I guess it's just something you would have to experience, I can't make you think or feel what we feel." My point is that I already do feel what you feel - full when my stomach has enough food, hungry when it's empty... the difference that I'm talking about is purely intellectual, and just comparing my feeling about half a cup of food vs. my feeling about a cup and a half. I'm glad I can eat that extra amount, because it works for me intellectually, whereas I don't think being limited to half a cup would. And I don't think that the difference in the restriction types makes a difference to one's intellect - if someone is happy with half a cup, then that's great, but if they're not, no surgery is going to change that (other than a lobotomy, perhaps -- which is probably what I need). You finally said: "WLS Does work..and notice I said WLS that includes your surgery as well.. I'm proud of us..aren't you?" I certainly am!!!!!!!!!!!
— Kim H.

March 28, 2000
KIM: I thought BPD/DS is a Biliopancreatic Diversion...with duodenal switch.. Which derived from the Jejuno-ileal Bypass (JIB)...Which is not a Roux en Y . Yes they are all Gastric Bypass's and the DS is similar to the RNY with respect to the intestinal bypass (malabsorptive) portion of the procedure, maybe that is what you meant, but is not classified as a RNY at all. The RNY and DS are very different with respect to what is done at the top end of the surgery -- the portion involving the stomach (the restrictive aspect of the surgery) however, I was still under the assumption that the DS was derived from the Jejuno-ileal Bypass then Biliopancreatic Diversion procedure... Maybe I'm wrong. Wouldn't be the first time......
— Victoria B.

March 28, 2000
Vicki - in my earlier post I said: "the original BPD (which is in and of itself a modified RNY)..." I should clarify that - the original BPD was developed using principles from the JIB and the RNY, so you are not wrong when you say that it's derived from the JIB. I think that each procedure that's come along has it's good points and bad points, and new procedures that follow try to use the good things (the malabsorbtion principle from the JIB) while eliminating the bad with components of OTHER surgeries that didn't have the same problems. It would be interesting to do an in-depth analysis of the different elements of the BPD/DS, to learn where each element originated (whether the RNY, JIB, VBG). Unfortunately, I don't have time right this second to do it, but if you're interested, I will work on it later.
— Kim H.

March 29, 2000
 Where my posted information below came from was: American Society for Bariatric Surgery (ASBS) Founded in 1983, foremost American surgeons have formed the society's leadership and have established an excellent organization with educational and support programs for surgeons and allied health professionals: I'm certainly not saying BPD-DS is the old JIB by any means, only that it derived from it and is the modern variant of JIB below is the complete write up at the ASBS website the address follows: http://www.asbs.org BILIOPANCREATIC DIVERSION: (BPD) A modern variant of the Jejuno-ileal Bypass (JIB) is Biliopancreatic Diversion,(BPD), a procedure which differs from JIB in that no small intestine is defunctionalized and, consequently, liver problems are much less frequent. This procedure was developed by Professor Nicola Scopinaro, of the University of Genoa, Italy.(Scopinaro, Gianetta et al. 1996) This procedure has two components. A limited gastrectomy results in reduction of oral intake, inducing weight loss, especially during the first postoperative year. The second component of the operation, construction of a long limb Roux-en-Y anastomosis with a short common "alimentary" channel of 50 cms length. This creates a significant malabsorptive component which acts to maintain weight loss long term. Dr Scopinaro recently published long term results of this operation, reporting 72% excess body weight loss maintained for 18 years. These are the best results, in terms of weight loss and duration of weight loss, reported in the bariatric surgical literature to this date. From the patient's perspective, the great advantages of this operation are the ability to eat large quantities of food and still achieve excellent, long term weight loss results. Disadvantages of the procedure are the association with loose stools, stomal ulcers, offensive body odor and foul smelling stools and flatus. The most serious potential complication is protein malnutrition, which is associated with hypoalbuminemia, anemia, edema, asthenia, alopecia, generally requires hospitalization and 2 - 3 weeks hyperalimentation. BPD patients need to take supplemental calcium and vitamins, particularly Vitamin D, lifelong. Because of this potential for significant complications, BPD patients require lifelong follow-up. In BPD patients who have received 200 - 300 cm alimentary limbs because of protein malnutrition concerns, the incidence of protein malnutrition fell dramatically to range from 0.8% to 2.3% Variants of this operation have been devised in an attempt to reduce the incidence of stomal ulceration and diarrhea using the techniques of sleeve resection of the stomach which maintains continuity of the gastric lesser curve and duodenal switch which maintains continuity of the gastro-duodeno-jejunal axis.(Marceau, Biron et al. 1993) This technique essentially eliminates stomal ulcer and dumping syndrome. BPD and its variants are the most major procedures performed for obesity and it follows that prospective patients who wish to consider BPD should seek out experienced surgeons with life-long follow up programs. Listing of complications of biliopancreatic diversion: Protein Malnutrition 15% Incisional hernia 10% Intestinal obstruction 1% Acute biliopancreatic limb obstruction Stomal Ulcer 3.0% Bone Demineralization: Pre-op 25%; at 1-2 yrs, 29%; at 3-5 yrs 53%; at 6-10 yrs 14%. Hemorrhoids 4.3% Acne 3.5% Night Blindness 3% Operative Mortality 0.4% - 0.8% (1122 subjects, 1984-1993) ====================================================== JEJUNO-ILEAL BYPASS: (JIB) Two variants of jejunoileal anastomosis were developed, the end-to-end (Scott)(Scott, Dean et al. 1973) and end-to side(Payne) (Payne and DeWind 1969) anastomoses of the proximal jejunum to distal ileum. In both instances an extensive length of small intestine was bypassed, not excised, excluding it from the alimentary stream. In both these variants a total of only about 35 cms (18") of normally absorptive small intestine was retained in the absorptive stream, compared with the normal length of approximately 7 meters (twenty feet). In consequence, malabsorption of carbohydrate, protein, lipids, minerals and vitamins inevitably occur, Where the end-to-side technique was used, reflux of bowel content back up the defunctionalized small intestine allowed absorption of some of the refluxed material resulting in less weight loss initially and greater subsequent weight regain. Bile is secreted by the liver, enters the upper small intestine by way of the bile duct, and is absorbed in the small intestine. Bile has an important role in fat digestion, emulsifying fat as the first stage in its digestion. Bypassing the major site of bile acid reabsorption in the small intestine therefore further reduces fat and fat soluble vitamin absorption. As a result, huge amounts of fatty acids which are normally absorbed in the small intestine, enter the colon where they cause irritation of the colon wall and the secretion of excessive volumes of water and electrolytes, especially sodium and potassium, leading to diarrhea. This diarrhea is the major patient complaint and has characterized jejunoileal bypass in the minds of patient and physician alike since the procedure was introduced. Bile salts help to keep cholesterol in solution in the bile. Following JIB, the bile salt pool is decreased as a consequence of reduced absorption in the small intestine and bile salt losses in the stool. The relative cholesterol concentration in gallbladder bile rises and cholesterol crystals precipitate in the gallbladder bile, forming a nidus for development of cholesterol gallstones in the gallbladder. Specific vitamin deficiencies also occur, Vit D and Calcium deficiencies lead to thinning of bone with bone pain and fractures as a result of osteoporosis and osteomalacia. Bypass of the terminal ileum which is the specific site of Vitamin B12 absorption, leads to Vitamin B12 deficiency with a specific peripheral neuropathy. Vitamin A deficiency can induce night blindness. Calcium Oxalate renal stones occur commonly following JIB, along with increased colonic absorption of oxalate. The colonic absorption of oxalate has been attributed to: Exposure of colonic mucosa to excessive bile salts and possibly bile acids, increasing colonic permeability to oxalate or: Excessive quantities of fatty acids in the gut form soaps with calcium, reducing its availability to form insoluble calcium oxalate leading to the persistence of soluble and absorbable oxalate in the colon. Patients with intestinal bypass develop diarrhea 4-6 times daily. The frequency of stooling varying directly with fat intake. There is a general tendency for stooling to diminish with time, as the short segment of small intestine remaining in the alimentary stream increases in size and thickness, developing its capacity to absorb calories and nutrients, thus producing improvement in the patients nutrition and counterbalancing the ongoing weight loss. This happy result does not occur in every patient, but approximately one third of those undergoing "Intestinal Bypass" have a relatively benign course. Unfortunately, even this group is at risk of significant late complications, many patients developing irreversible hepatic cirrhosis several years after the procedure. JIB is the classic example of a malabsorptive weight loss procedure. Some modern procedures utilize a lesser degree of malabsorption combined with gastric restriction to induce and maintain weight loss. Any procedure involving malabsorption must be considered at risk to develop at least some of the malabsorptive complications exemplified by JIB. The multiple complications associated with JIB while considerably less severe than those associated with Jejunocolic anastomosis, were sufficiently distressing both to the patient and to the medical attendant to cause the procedure to fall into disrepute. Listing of jejuno-ileal bypass complications: Mineral and Electrolyte Imbalance: Decreased serum sodium, potassium, magnesium and bicarbonate. Osteoporosis and osteomalacia secondary to protein depletion, calcium and vitamin D loss, and acidosis, Protein Calorie Malnutrition: Hair loss, anemia, edema, and vitamin depletion Cholelithiasis: Enteric Complications: Abdominal distension, irregular diarrhea, increased flatus, pneumatosis intestinalis, colonic pseudo-obstruction, bypass enteropathy, volvulus with mechanical small bowel obstruction. Extra-intestinal Manifestations: Arthritis Acute liver failure may occur in the postoperative period, and may lead to death acutely following surgery. Liver disease, occurs in at least 30% Steatosis, "alcoholic" type hepatitis, cirrhosis, occurs in 5%, progresses to cirrhosis and death in 1-2% Erythema Nodosum, non-specific pustular dermatosis Weber-Christian Syndrome Renal Disease: Hyperoxaluria, with oxalate stones or interstitial oxalate deposits, immune complex nephritis, "functional" renal failure. Miscellaneous: Peripheral neuropathy, pericarditis. pleuritis, hemolytic anemia, neutropenia, and thrombocytopenia. The multiple complications associated with JIB led to a search for alternative procedures, one of which was gastric bypass, a procedure which is described in detail later. In 1983 Griffen et al. reported a comprehensive series comparing the results of jejuno-ileal bypass with gastric bypass. 11 of 50 patients who underwent JIB required conversion to gastric bypass within 5 years, leading Griffen to abandon jejuno-ileal bypass.(Griffen, Bivins et al. 1983) JIB can be summed up as having: Good Weight Loss, Malabsorption with multiple deficiencies, Diarrhea. As a consequence of all these complications, jejuno-ileal bypass is no longer a recommended Bariatric Surgical Procedure. Indeed, the current recommendation for anyone who has undergone JIB and still has the operation intact, is to strongly consider having it taken down and converted to one of the gastric restrictive procedures. 
— Victoria B.

March 29, 2000

— Victoria B.

March 30, 2000
Vicki, thank you for your post. The American Society of Bariatric Surgeons even supports my assertion that the BPD/DS is a variant of the RNY with the following statement: "The second component of the operation [is the] construction of a long limb Roux-en-Y anastomosis with a short common "alimentary" channel of 50 cms length." Perhaps those who disagree with my original assertion can address this?
— Kim H.

March 30, 2000
No, I don't see that assertion.. Their Statement Reads...The BILIOPANCREATIC DIVERSION: (BPD) is A modern variant of the Jejuno-ileal Bypass (JIB) is Biliopancreatic Diversion,(BPD), a procedure which differs from JIB in that no small intestine is defunctionalized and, consequently, liver problems are much less frequent. This procedure was developed by Professor Nicola Scopinaro, of the University of Genoa, Italy.(Scopinaro, Gianetta et al. 1996) What you're assuming is because since they hook up to the same set of tail pipes then they must be the same vehicle.. ;-)
— Victoria B.

March 30, 2000
Read down a little further, Vicki.
— Kim H.

March 30, 2000
Sheila: I certainly agree with you.. These surgeries all of them have come along way.. And the "New" variations all have greatly improved.. And I will repeat again if RGB had not been available to me, I would have had the DS.. So don't get me wrong and thing I'm knocking the surgery I'm not by at means. Just posting information for the members. ;-) Kim: I read the whole statement from ASBS no where did it say DS was derived from RNY. If you're referring to the similarities ..I never said they weren't similar. ALL gastric Bypass Surguries had to start somewhere..
— Victoria B.

March 30, 2000
Correcting typo's: ;-) And I will repeat again if RGB had not been available to me, I would have had the DS.. So don't get me wrong and think I'm knocking the surgery I'm not by any means.
— Victoria B.

March 30, 2000
who cares who was right as to where the DS came from....I am not here to argue, I just like the information.....and personally I think that Vicki is a great source of info.....
— paul F.

March 30, 2000
Vicki - you said: "I read the whole statement from ASBS no where did it say DS was derived from RNY." Vicki, the ASBS description that you posted states that the BPD is made up of two components, one of which is the construction of a long limb Roux-en-Y anastomosis. This is the ASBS' language, not mine. The "duodenal switch", as I stated before, refers to "switching" the duodenum from the bypassed portion of the intestine (as in the original RNY) to the alimentary portion. I have a feeling I am not explaining this clearly, so if you have specific questions, please post them. It will help me to clarify my answer for you.
— Kim H.

March 30, 2000
Paul Frederickson...there is no email address on your profile. Please contact me via email. You'll find the address by clicking on my name.
— Roseann M.

March 30, 2000
I am a little confused. More than half of the answers here have absolutely nothing to do with the question that was asked. And if it helps, Kari, I am doing about what you are. My calories are anywhere from 500-700 each day and my fat grams are about 20-25. I am getting 70 grams of protein and I have lost 47 pounds in 2 months. I have about 80 to go. I have more energy than ever and am not tired at the end of the day. And for the rest of you, it is all Fords and Chevys as far as I am concerned. We have all had our surgery for our reasons and each one of us seems to be having the outcomes we hoped for. Get over it already!
— S S.

August 9, 2000
THE LOWFAT LIFESTYLE Most food labels give the percentage of calories from fat, but many do not. Here's how you can calculate the percentage of calories from fat: This equation can be used on any food item which contains the nutritional information of calories per serving and grams of fat per serving. Locate the nutritional information on the label. Identify calories per serving and grams of fat per serving on the food label. Fat contains nine calories per gram of fat. To determine the percentage of fat calories: a. Multiply the grams of fat per serving by (9). b. Divide that number by the number of calories per serving. c. Multiply by (100). This equals the percentage of calories from fat. Remember, you want it to be less than 30%. EXAMPLE: 95% FAT FREE HAM SLICES..Nutritional Information (per serving): Calories (55) Protein (7gms) Carbohydrates (Ogms) Fat (3gms) Servings per package (4) Serving Size (1oz) EQUATION: 3 grams of fat x 9 ------- 55 calories per serving x 100 = 49% ....Practically 50% (1/2) of the calories in this food product come from fat. This does not fall within the recommendations of 20-30% of the calories from fat. You should choose another meat product which is leaner. DESIRED: Meats: < 3g Fat, < 480mg Sodium per 2oz < 3g Fat, < 1g Saturated Fat, < 200mg Sodium per 100 calories < 3g fat, < 1g Saturated Fat per 1oz cooked and well trimmed list meats There are now many "fat-free" food products which are just as appetizing as their fat-rich counterparts. However, READ LABELS CAREFULLY! Many fat-free items may contain hidden sugars. Also many sugar-free products may contain hidden fats. READ LABELS CAREFULLY! Beware of "LITE" food products. The term "LITE" is often given to a food in which water or air has been added, yet it is the same product which still contains too much fat or sugar. EXAMPLE: canned fruit in "LITE" syrup still contains a significant amount of sugar. It is best to choose canned fruit with "No Sugar Added". **I usually get in 20-25 fat grams a day, sometimes under .. I'm down 144 pounds in 8 months.. Use this program to accurately keep tract of your nutritional needs www.dietwatch.com it's FREE download operates online... Visit my profile page for more information, links and recipes..
— Victoria B.

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