Question:
How is malabsorption an issue once your weight is stabilized?

I understand the malabsorption issue while you are losing weight and following your surgery. However, 18-24 months out, when you have lost all your weight and are stabilized, how are you still malabsorbing? If your weight is steady, doesn't that mean you are getting all your nutrients? Especially those that have to be really careful to weight gain. How can you gain weight and still malabsorb? I'm still pre-op and have all intentions in the world of taking my vities for life, but was just curious.    — Denise B. (posted on July 9, 2003)

July 9, 2003
Please forgive me if this information is not correct, but I will pass on my understanding of what my surgeon told me in my pre-op information session. He told us that we will always malabsorb, but to what extent is not known. He said that after time, our bodies will begin to adjust and adapt, and will absorb more than at the beginning. Another reason out weight stabilizes is that he said eventually, your body will find it's "set point" and your metabolism will change. Rather than your body being in a losing mode, where there is a calorie deficit, your body will start using your calorie intake more efficiently, and hold onto weight and fat...that's when the real work begins, and you have to be like every other person out there who struggles with "those 10 (or 20 or whatever) extra pounds". This is my understanding of my doc's take on it all... I'd love to hear what others think too.
   — Kelly B.

July 9, 2003
I'm still pre-op... however it is my opinion that just because your weight stablizes, that only means that you are taking in the amount of calories equal to the amount of calories your body uses. That does *not* mean you are getting all of your necessary nutrients. You most definitely can gain weight and still malabsorb. If you take in more calories than you expend, you will gain weight. It may mean that you have to eat more quantities of food to compensation for the malabsorption, but in the end, you'd gain weight.<P> And if you didn't not eat the right foods, you'd end up missing your nutrients too, regardless. Hypothetically, you could maintain your weight loss eating nothing but banana splits, yet you could be malnourished because you weren't getting enough vitamins and minerals. Just my 2-cents.
   — Jolinda C.

July 9, 2003
According to my surgeon who happens to perform both the RNY and the DS, he stated in a recent meeting that for the RNY patient very little of the digestive tract is bypassed (he only performs the proximal RNY), and that after the weight loss phase (window of opportunity) closes, the body adapts to it's new system and very little malabsorption, if any at all, will take place after 2 years. <p>But the story is very different for the DS surgery. All but the last 3 feet of small intestine have been bypassed. True, the common channel will adapt by expanding in circumference and growing longer over time, but it will never fully adapt and there will always be significant malabsorption for the DS patient. For people like me, that is a gift because I needed this malabsorption to boost my sluggish metabolism. I welcome it and will gladly take vitamins to supplement the loss of nutrients, because I am living the dream I always wanted. After 47 years of starving myself, I can finally able to eat normal amounts of food without obsessing over calories, fat, and sugar and the guilt of eating something "not on my diet". <p>Some people prefer the RNY because they are junk food addicts, but I never was. I just couldn't burn what few calories I was ingesting. Now I can eat until I am content--approximately 2000 - 2500 calories a day and I don't worry a bit about weight gain. I don't think a RNY patient can eat like that--basically because their body's metabolism has slowed down because of the restriction of the RNY pouch. That is why a large number of long-term postop RNY patients have to continue dieting. The appetite comes back, but the metabolism doesn't recover as well. It takes hard work to keep it off--exercise, avoiding certain foods, etc. And the malabsorption factor is no longer much of a factor after the weight loss phase. I often hear about long-term post-op RNY patients being hungry. Well, of course they are hungry. They have to survive on 1000 calories a day because their metabolism has been permanently altered (unless they exercise obsessively). I'm not saying ALL RNY patients are hungry and struggle with their weight, but there are a significant number that do, and it just makes sense as to why--no malabsorption, and a lowered/altered metabolism caused from long-term calorie restriction.
   — artistmama

July 9, 2003
Yep, gotta love that DS! :-D (But you do have to watch your intake of sugar and other carbs.)
   — Chris T.

July 10, 2003
For Brenda Z: Is your doctor saying that the RNY surgery is effective for only two years and then one is back to normal? It just doesn't sound right. Nina in Maine
   — [Deactivated Member]

July 10, 2003
As a previous poster said, they don't really know the extent to which the intestines are able to adapt to absorb more calories, etc. a couple of years after surgery. But, even if the non-bypassed portion of your small intestine adapts almost completely to the malabsorption, you will still not get all of your vitamins and minerals from food, for at least two reasons: your pouch will still be small enough that you will likely be eating less food than "normal" people do, thereby taking in fewer nutrients, and particular vitamins and minerals are absorbed at particular places in the small intestine. Calcium and iron, for example, are absorbed mainly in the upper portion of the small intestine. No matter how much the lower part of your small intestine adapts, you have still bypassed these key absorption sites. That's why we have to supplement vitamins and minerals for life: many of them will forever bypass their optimal absorption sites and will therfore always be absorbed to a lesser degree than in "normal" people. Take all of your vitamin and mineral supplements forever.
   — Vespa R.

July 10, 2003
To Nina, My surgeon is not saying the RNY stops working after 2 years. What he is saying is that the malabsorption component of the RNY is not much of a factor as an aid to continued weight loss and maintenance of weight loss. The continued maintenance of weight loss relies on the behavior of the patient after 2 years by continued restriction of calories and increasing or continuing an ongoing exercise regimen. Hope this helps to clarify. Thanks for asking.
   — artistmama