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How do you know if your body is going into malnutrition ?

on 11/10/10 3:31 pm
what would be the early signs or any signs?

I am at goal and i am hungry all the time and I can eat and eat and still lose weight not alot but body looks malnurished my shoulders are so thin.   I am 130 pounds and 4 11 inches tall ...Just wondering .......Thank you so much        Maricela">">>
(deactivated member)
on 11/10/10 3:34 pm
DS on 10/19/09 with
 How are your labs? Your results (protein counts, calcium, potassium and other standard vitamin levels) would be markers of malnutrition. 
(deactivated member)
on 11/10/10 3:35 pm
GMTA.  We were posting at the same time. lol
(deactivated member)
on 11/10/10 3:37 pm
DS on 10/19/09 with
 We posted the same minute and everything! Glad to be in such good company. 
(deactivated member)
on 11/10/10 3:34 pm
How are your labs?

Do you have symptoms that lead you to believe you are malnourished?

I was 130 and 5'6" and was not malnourished, I just looked too thin.

on 11/10/10 3:36 pm
Thank you is time for lab work soon">">>
on 11/10/10 3:39 pm

This may sound silly but when I eat I feel like I am straving for food and I get often....and of course protein first I focus on protein all the time... I really think is that the loose skins just doesnt help makes my body look weird  :)">">>
on 11/10/10 3:50 pm - Milwaukee suburb, WI
DS on 03/24/09 with
Funny bc I just posted my thoughts on this for the first time a couple days ago.  I think that people who have lost a massive amount of weight tend to look thinner at natural bony protrusion points for the same height/ weight in comparison to others who were never overweight.  I think the thinner skin (from having been stretched) that we have lays differently over these points & that we look thinner based on these points, vs what we may feel our bodies look like on other typical fatty areas like our stomach, thighs, hips, &  butt.  I also think the fact that we tend to have denser bones & weight from excess skin means that we can be heavier & look thinner than someone else who was never overweight.

About eating & eating . . . that's exactly where I am now.  I have tracked my food plenty of times in recent months - having reached goal and 18 months post-op.  I typically eat around 3,000 - 3,500 calories per day.  But, once I do the "DS math", it's typically around 1,400 - 1,600 calories.  I also tend to feel like I'm hungry all the time - at least, in comparison to "normal" people.  Of course, I'm not literally hungry every minute of every day, but hungry often enough that it's noticeably moreso than most people . . . & I eat more than most people.  So long as I stay in my weight range that I feel comfortable in, I'm not going to stress about it.  I found that I had gone up to 140 - 141 & went back to the basics for 3 days & went down to 138.  I'm fine fluctuating b/w that & 140.  If I eat a lot, but stay at that range, even I'm getting my protein in & my vites, then logically speaking, I don't think I should worry about eating a lot - that's my take on it.

HW / SW / CW / GW      299 / 287160 / 140     Feb '09 / Mar '09 / Dec '13 /Aug '10          

Appendicitis/Bowel Obstruction Surgery 8/21/10
Beat Hodgkin's Lymphoma!  7/15/2011 - 1/26/2012 

Ran Half-Marathon 10/14/2012

First Pregnancy, Due 8/12/14                             I LOVE MY DS!!!

Kayla B.
on 11/10/10 3:52 pm - Austin, TX
There is kind of a difference between "wasting away" physically vs viscerally, I guess.

In the visceral sense -- I'd say in order to be diagnosed with that type of malnutrition, you need lab values.  This would be protein values in the hole, including albumin, prealbumin, total protein.  Some people also experience edema...lower legs or tummy area.

You could be physically malnourished, which would be detected physically from loss of muscle tone.  The physically malnourishment would be caused from long-term calorie deficit.  Basically, you'd be skinny, and lacking muscle.  You can kinda see these places on the body - hands or temple area are pretty common places to look.  Having an indentation in the temple area is a pretty good sign...because there is typically a small muscle that should sorta "fill in" that area, but if your body is breaking down muscle, that muscle gets broken down and the skin starts to indent. 

So, you could have one, the other, or both (really bad!).

And then, each of those would be different than having low body fat.  When I think of malnutrition, I think of protein and muscle.

So, if you think your lab values are scary, the first place to start would be to check those.  That'll tell you whether you're getting enough protein and stuff.

Then, if you think you're getting too thin, it might be time to consider some digestive enzymes to get you by.

I'm thinking based on what you say, you might just be getting a little too thin...maybe losing too much fat or muscle mass for your liking.  How are you feeling otherwise?
5'9.5" | HW: 368 | SW: 353 | CW: 155 +/- 5 lbs | Angel to kkanne  
on 11/10/10 3:54 pm - South Central, PA
DS on 06/07/10 with
Bony shoulders here!  5'8", 179.  What can you do, ya know?

I'd say to check your labs, and make sure you're up on protein, vitamins and hydration.  If those are all well, then you're not malnourished.

Other than that, remember that many people "go low" in their weight after DS, then have a bit of a rebound, so if you're at or past goal and your surgery was a while ago, you may gain a bit in the next several months and level out.

Nicole  Lab rata data link- One-half of a DS couple!  - I'M BELOW GOAL!  After a very rough start it's official--I my DS!  Romans 8:28 
Looking for DS information? Start at and 
LilySlim - Personal pictureLilySlim Weight loss tickers         
Julie R.
on 11/10/10 4:31 pm - Ludington, MI
Well, I am 5'4 and between right in the mid 120s and I don't look malnourished, but individual results do vary.    It seems we all get pretty bony through the shoulders and upper arms.   My back is really bony too.    Those are pretty naturally thin areas for most women, I think.    I've been able to build some muscle mass back up and it looks better.

Your labs, for the most part, are going to determine malnourishment.   You're kind of at that stage in your weight loss where it's still riding along on it's own.  Most of usually settle down, don't worry.   If you continue to lose below a normal BMI (which for your height is a ways off)  or your labs show deficiencies, then it's time to reevaluate the situation. 
Julie R - Ludington, Michigan
Duodenal Switch 08/09/06 - Dr. Paul Kemmeter, Grand Rapids, Michigan
HW: 282 - 5'4"
SW: 268
GW: 135
CW: 125

(deactivated member)
on 11/10/10 7:55 pm
I think labs are the best way to tell.

I don't think there is one real symptom of malnourishment. Perhaps extreme fatigue and light headed/dizzyness, but those are vague symptoms and can present themself with lots of other problems.

I will say that when I had my stricture, I was extremely malnourished and had no idea how sick I was until I was starting to feel better. Weird huh? It was also a rapid progression, which scares me looking back on it.

How are your labs?
(deactivated member)
on 11/10/10 7:57 pm
Malnutrition is essentially when certain nutrients are lacking.  Unfortunely weight is not a good indicator as you can be 500 lbs and be malnutritioned.  Your shoulders being thin at 4 11, 130 lbs is really your body habitus and nothing esle, you could easily weigh <100 and still be normal body weight.  The way to clinically know if you are having issues it to have blood work to test for micronutrients.  (I mean you can look at someone's skin, eyes, hair, but this would only show it is was severe)  Make sure you have your usualy ds post op blood work to check for your overallhealth status.

on 11/10/10 8:05 pm
Thanks to Everyone...I am up for some bloodwork labs very soon... I will fight with my PCP to run all these labs for me cause my surgeon doesnt run very many...I will work on that and get back with results and we will take it from there...

Thanks again
Blessings to all

(deactivated member)
on 11/10/10 8:19 pm
Have him look at your fingernails. A nurse in the hospital told me she could tell if a person was malnourished by looking at their fingernails.  If they curved inward and were brittle, there was usually a deficiency.

Hope everything is alright!
Ms. Cal Culator
on 11/10/10 9:43 pm - Tuvalu
On November 10, 2010 at 8:05 PM Pacific Time, unique0731 wrote:
Thanks to Everyone...I am up for some bloodwork labs very soon... I will fight with my PCP to run all these labs for me cause my surgeon doesnt run very many...I will work on that and get back with results and we will take it from there...

Thanks again
Blessings to all


You need to take a list with you and you NEED those labs.

You have "surgically induced malabsorption."  If you don't stay on top of those labs, you could get very, very sick.  Also, you might ask for a referral to an endocrinologist to help you stay on top of all of the supplements and vitamins you need to take.
on 11/11/10 6:52 am
DS on 09/08/09 with
Looking slender is different from looking malnourished. There are outward signs, but by the time you start to see it, it's out of control. The signs early on I should have paid attention to were hair loss, dry skin, and cracks at the corner of my mouth. (I did pay attention and tried to correct with the appropriate vite or more shakes but it was already too out of control)
The physical signs earlier on I should have paid attention to were thrush/yeast infections, weakness, lack of energy/feeling exhausted. The thing is, I got mixed messages because I had also started working outside of the house and it took 2 weeks to go from signs of illness to a full blown dangerous situation. I thought that it had to do with my new job taxing me out.
The signs later on started with more weakness. The kind where I couldn't any longer take the stairs up to my house one foot at a time because of weakness and lack of balance. Standing on one foot would send me tipping right over. Oh, and I remember trying to take a bath and getting really scared because after I leaned my head back, I felt like I couldn't raise it back up and thought I would drown myself, so I got out of the tub. My skin started to peel right off wherever my clothes rubbed or shoes. So I had pressure point skin breakdown. By the time I got to the hospital, I had a scab in the shape of a V on my foot from my sandals, butt bones skin breakdown and my back peeled where my bra touched.
To back up again, the next signs were mental. I felt like I couldn't concentrate or remember anything. I remember getting lost on my way back home from work one day and getting so confused about how to correct my path. Sleep disturbances and sweating in my sleep. I often felt like I was hyper and anxious like I had drank a ton of coffee but at the same time, no energy to use that feeling. Also, if I were mentally intact, I would have been able to see how sick I was but I couldn't put two real good thoughts together and stayed in denial as well.
I started swelling and it was mostly the classic "pedal foot" edema, although I was swollen all over I realized later on. If my feet were down for even 1 minute, they blew up. The next  late signs came together and were scary as hell. They were heart palpitations and shortness of breath. I felt like I was breathing in syrup and my heart beat rapidly and wildly. By this time, I was really mentally confused. The day I went to the ER, I couldn't lift my own leg into the car without help, my head felt like it weighed a thousand pounds on my neck and I couldn't hold my head up literally.
Now I want to stress that it was no more than a month from the first sign to the day I was admitted into the hospital as severely malnourished. We have a really awesome surgery with a lot of power, and with that comes a lot of responsibility.
I want to say that I hope my experience doesn't scare anyone, but actually...I guess I am hoping it does. This is why I believe it doesn't matter if you don't like the taste of your protein shake, it's really not about what you like. If you can find supplements that are pleasant, that's awesome. If not, then it's like everything else in life that isn't fun, we just sometimes have to do it. It doesn't take long for us to get ill from malnutrition, but it takes us a long time to recover.

I'll some pics in my profile of what I looked like a month into recovery. I think if it was something we could spot with the naked eye, I'd never gotten that sick.  I wouldn't let anyone take photos of me while I was that sick, but I did let my husband take a few while I was recovering a month later, still with my feeding tube and to me, I look like death warmed over, so I can imagine how bad it must have been before.

This is a month out from my revision and recovering from malnutrition. eptember-2010/#photo

5'1 HW 298 CW 118

"Making America skinny, one slap atta time!" -Slap Chop Dude

(deactivated member)
on 11/11/10 7:31 am
This made me want to cry. After reading your post, I realized just how many symptoms I really did have, but thought were normal.

It does creep up on you, and fast. I wish that in the beginning I didn't self-diagnose. I had horrible yeast infection/thrush that wouldn't go away and I'm still battling it. I  had severe weakness as well. I did get dizzy and almost blacked out quite a few times. It got to the point I could barely bathe myself because I lacked energy and I kept assuming it was normal. That was my biggest fault. I was trying too hard to keep my big girl panties on and didn't want to come on here and complain about all of my problems that I thought were.. normal.

You just made me think of the walking up the stairs bit. That was hell for me and something I am still struggling with, just not as bad. I had to really concentrate and hold on to both rails and even then I would feel like I was about to fall backwards. Getting my first leg up the step was the biggest challenge. It was like lifting an entire person when I hadn't been trained to lift that much. Sometimes I would lose my balance a little, but I never fell from it.

Mentally, I was all over the place. I was blaming MYSELF and everything I put in my mouth for my stricture symptoms. I thought I was causing the problem when I was eating foods that everyone else at my stage was eating. I thought I was causing the problems by sleeping too much when I should of been awake trying to hydrate myself.

I wasn't thinking normally and am still recovering from that as well, I really believe that it lead me into a deep depression. Who thinks that chicken flavored broth is the root of your vomiting? Ugh.. I DID! And when it was a different kind of soup, it was a different reasoning for the vomiting "Oh, I ate too much" (when I'd of had 2 teaspoons) or.. "Oh, it's the salt" or "There's probably sugar in this that isn't listed." or "Oh, it's too acidic" WTH!

My mouth got so dry that I couldn't keep it hydrated. I would wake up in the middle of the night and want to gulp water, and could only get in a sip or two before the vomiting started. I started sitting there with ice cold water in my mouth letting it just sit on my tongue for relief.

I think, for me, it attacked me mentally before physically. My Mom said I would stare off into space like an alien and I just didn't seem right and I kept assuring her that I was okay and it was just all surgery related and it'd pass soon and I'd be fine. Then I'd sleep for most of the day and all throughout the night.

The one thing I regret was being too passive in my healthcare and assuming everything was surgery related or my fault. I was trying too hard to just stay strong and "fight the bump in the road". I thought all of my symptoms were normal after surgery and it wasn't until I was fighting desperately to keep myself alive that I realized it wasn't normal.

I had called my surgeons office a few times about the nausea and vomiting they just re-inforced that it was normal and kept writing me different prescriptions for reflux and nausea and telling me to go back to basics when I already was at stage 1. I remember my Mom on the phone yelling at the ladies @ my surgeons office. She was getting livid because they wanted to just write me another prescription and not have me go in and be seen. This was AFTER 2 ER trips to get hydrated and vitamins.

My nails were brittle, cracking, my hair falling out in massive clumps, my skin was pale and did rub off everytime I got into the shower. It was also very dry and cracking. I was itching constantly. What did I do? Assume it was medication given to me from the surgery. Assumed the hair falling out in massive clumps was normal since I read after WLS hair falling out is normal.

I didn't have the anxiety and heart palpitations or swelling, but I have a feeling that was just around the corner. I did have horrible night sweats.

I don't know how I missed it. All of the signs were there, but mentally, I wasn't able to catch it.  It still scares me looking back on it.

Did you also not realize how sick you were until you started feeling better?

(((HUGS))) I'm so sorry you had to endure this. It's not a fun place to be and it's not fun to climb out of.
on 11/11/10 8:35 am
DS on 09/08/09 with
While I don't wish this on my worst enemy, I am grateful that I have friends like you who share with me and it keeps me from feeling alone. I have a few people who share with me privately about their struggle. I think I felt guilty and ashamed of how bad I let it get. It seemed that I had failed my peers to have let it get so out of control. I wanted to set a GOOD example and be a model patient. I thought that if I just read more, took more vites, drank more shakes, I could pull myself out without any help.
And oh boy did I have those crazy thoughts about what was causing this. I had even blamed my B complex at one point.
To me the face of malnutrition looked like an 80 pound anorexic or a 3rd world child eating porridge. I just needed to adjust to my new job, up my shakes and take some extra vites. The swelling I thought was of course sodium intake. The crazy thirst you spoke about was just a good opportunity to get more fluids in. The weakness was my body's tendons stretched out from being SMO and they just needed to tighten up on my new frame. My skin and hair were like you, just a temporary side effect of surgery and weight loss and would get better soon. The new shoes certainly caused my feet to peel. C R A Z Y!!! It wasn't until I couldn't freakin breathe that I decided to see what the board thought!  

I didn't realize how sick I was till I looked back. Now, I am still floored at it all. One of the sad but funny moments was in hospital after having the revision, still on TPN, and a feeding tube, I went into hysterics because I wanted a smaller bed because my bed was too big and it made it hard to get in and out to use the bathroom. I was dead serious and felt like no one was listening to me or understood that it felt like I was climbing a mountain to just pee. Phew girl...I am so glad we made it this far.

5'1 HW 298 CW 118

"Making America skinny, one slap atta time!" -Slap Chop Dude

on 1/16/11 10:07 am
Revision on 07/19/11 with
You have described how wls has effected me also, what did you do to make it better?  You are describing things that have happened or happening now and no clue as to what is needed.  Extrmely confused.  Reading the post you two have made it,  how can I prevent  things getting worse?