Question:
Can someone define Malabsorption for me?

OK, I must admit that I have never fully understood malabsorption. I had LAP/RNY and my surgeon bypassed 75cm of my small intestines. I was wondering what my rate of malabsorption should be. I understand that everyone does it at a different rate but is there a general rule of thumb to go by? When I eat food how much is really being absorbed? How are calories and carbohydrates effected? I probably need to find a nutritionist or a dietician that is familiar with WLS. Thanks all!    — Kim W. (posted on July 11, 2003)

July 11, 2003
Because food, after being digested in the stomach, is sent into the intestines where it is absorbed into the body (nutrients through the blood, hormones from genetically altered corn to your forehead for the third eye and fat to your hips), the amount of the intestine that is bypassed determines how much malabsorption you will have. The more of the intestine that is bypassed (i.e., that will not have digested food coursing through it) means that fewer calories from that food that will be absorbed into the body and that less of the nutrients from that food will concominantly be absorbed. With the DS/BPD surgeries, the amount that is bypassed is huge so patients have to strictly follow a vitamin program (of course, their weight loss results tend to be spectacular and very long-term). With most RNY's, only a marginal amount of intestine is bypassed (partly because many surgeons feel that it would be tough for patients to have greatly diminished capacities and a greatly reduced ability to utilize the nutrients that are being consumed). Although, the very nature of the RNY dictates that some of the intestine by bypassed. So, the bottom line (pardon the pun) is that the amount of intestine bypassed in a typical RNY won't have an impact on your ability to withstand (and feel compelled to eat more) from carbs and will probably only have a marginal (at best) effect on calories. I try to make all my food decisions based upon what nutrients my body needs (as well as what ridiculous craving and food demon is gnawing away at me the most aggressively). I don't consider how much of what I am eating will not be absorbed because I don't want to start playing head games with myself to rationalize bad food choices. Hope this answer helps. RNY's the issue of malabsorption isn't a major concern
   — SteveColarossi

July 11, 2003
In plain English, malabsorption is your body's inability to absorb vitamins, minerals, carbs, calories, etc. from the foods you eat or drink. In direct opposition to the previous poster (sorry, dude!), RNY wls does create malabsorption, and you must be concerned with getting enough vities and minerals to keep healthy. Don't try to do this all through the foods you eat. Instead, take a good multivitamin and stop worrying! My dietician/nutritionist works with both RNY and DS wls patients and suggests taking double the amount of daily multivitamin just to ensure proper absorption of the 100% suggested daily values. What we actually eat is a bonus to this amount. If you are wondering if you need to eat more to get the right amount of vities, etc. DON"T! Take those multis and stay on the diet. See my profile for diet help, or email me if you want to talk more about this! :~)
   — Sharon M. B.

July 11, 2003
Actually, both Sharon and Steve are right. Right after surgery, you will have the highest level of malabsorption of calories and fat, and vitamins and minerals. However, your body begins to adapt to the surgery and the intestine will gradually increase its size and the number of cilla within it. The adaptation will lead to greater absorption of calories and fat, especially, but will have a much lesser affect on the absorption of vitamins and minerals Vitamins and minerals are absorbed at particular receptor sites within the intestines. If the preferred receptor sites are within the part of the intestine that was bypassed (such as where calcium and iron are ideally absorbed), then you will always have malabsorption of those nutrients. Therefore, you need to take your vitamins and mineral supplements religiously for the rest of your life, but you will eventually absorb more calories and fat (and somewhat more vitamins and minerals) as your intestine adapts.
   — Vespa R.

July 12, 2003
Honestly, I don't think anyone really knows the rate of malabsorption. I don't think there's been extensive research into it. My doctor wouldn't/couldn't give a figure when he was asked that question recently at a support meeting, and I know that other doctors seem reluctant to put a percentage on it too. He did say that the rate of malabsorption decreases further out as the rest of your intestines learn to do the job of the missing portion - much like how when someone has brain damage in one portion of the brain, another part of the brain can sometimes take over that function.
   — sandsonik

July 12, 2003
I have a sort of "canned" description. Hope it helps you with the concept. While hypertrophy will occur, it is important to remember that your ileum is never going to replace the (out of the loop) stomach, duodenum & jejunum, so the basic 8 elements will always have to be addressed & watched. ..... Try this and see if it works. If not, I'll go into more detail. Fold a paper towel into 4 and pour 1/4C water on it. Absorbed? Fold a same sized waxed paper the same way & pour the 1/4C water on it. Absorbed? (no, it's a mess!) Use 1/4 sheet of the paper towel & pour the 1/4C on it. PARTIAL absorption. Once we have had RNY or BPD or DS, we lose our ability to digest certain elements in their entirety. The only ones we digest & absorb fully are SUGARS. The digestion does not occur in a normal fashion, so absorption is limited. The various surgeries break down into a thousand components within each type, but in essence, some of us will absorb almost nothing from food, some will absorb a little, some will absorb half way in between. WE will all mal-absorb (literally: bad-absorption), the same basic elements: protein calcium iron A, D, E zinc B12 (maybe potassium & magnesium) some fats/oils some complex carbs We will never malabsorb sugars. Did I say that? Let me say it again: sugar will sabotage your surgery, utterly.
   — vitalady