I had Duodenal Switch in 1999.  Went from 410 to 155-165 over a period of 2 years.  Then I lost more and was holding at about 145-150.

Have malabsorption issues with most items and get iron infusions several times per year.

Recently over the past 6 months or so I lost more weight and am down to about 128. I am skin and bones for me.  It was discovered that I have slightly elevated liver enzymes which led them to do an Utrasound and CT Scan of liver.  I've been diagnsed with Fatty Liver Disease and they say that can be reversed with diet.  So I'm eating only lean meats, veggies, fruit, salad, cereal and whole grains.  I must avoid fatty and sugary items, processed foods, alcohol, tylenol and anything that can put a strain on my liver.

In doing some research...it seems I may have Kwashiorkor Disease...which can lead to Fatty Liver Disease.  I  have all symptoms of Kwashiorkor.

Does anyone have this disease and can you tell me anything about your experience with it?

Thank you...Cheryl

Cheryl,

Is there supposed to be a direct correlation between your post ds diet and Kwashiorkor Disease?  I am pre-op and I hear all the comments about high fat levels that others eat after the surgery and I'm curious as to whether or not there is a link.

Thanks

I'm not sure if there is a confirmed direct link that Kwashiorkor or fatty liver disease result from DS surgery and the malnourishment that happens because of it.

I'm investigating it all as I was led to believe there might be a connection.

I personally do not absorb much as I should from food...so I'm looking to better that absorbtion from food and supplements.  Like iron infusions. I do not absorb much iron in pill form and what I do absorb is not worth the digestive problems iron supplements cause.  So I'll have to have iron infusions rest of my life.

Back in 1999 when I had the surgury...they didn't know as much as they know now.

Would I do it again...absolutely!!!  :-)

Have you had your labs checked lately? How much protein are you getting in per day?

Thanks for responding...

I've not had my levels specifically checked in 6 months...when I had a complete check up then my family doctor told me protein looked OK.  Though a lot can happen in 6 months.

I don't track protein in detail but I'd guess approx 90 as I have lots of cheese, greek yogurt, and meat for dinner and lunch.

It seems I need to start tracking it, see my surgeon or nutritionalist to get real levels...etc.

 This sounds a lot like the symptoms if protein malnutrition. Have it checked! 

Thanks Shannon...will do!

How many grams of protein are you eating daily? Has this changed since you diagnosis? Has anyone suggested treating you with pancreatic enzymes?

Kwashiorkor is a form of protein malnutrition. Pancreatic enzymes will help you better absorb protein.

As a DSer, you only absorb about 20% of the fat you eat. I doubt your doctor realizes this---most doctors, even some bariatric ones, don't. Eating a low-fat diet isn't going to do anything for you except make you constipated. Exactly what sort of doctor is treating you for this? PCP? Endocrinologist? Who did your DS, and do you still see him or her for your annual blookwork?

I've never tracked protein grams in detail but I'd guess about 90 grams due to eating a lot of cheese, greek yogurt and meat for lunch and dinner.

Just been a few weeks since I was told I had fatty liver. Going to get blood drawn next week.  I'll see if he can check protein.

Almost seems like a catch 22 situation...have fatty liver becuase of too little protein and too much fat...and eating a low fat high protein diet will make me lose more weight.

I have tried the enzymes 2 years a go but surgeon said I didn[t need them any long.  The are called Zenpep.  I have some...I suppose it wouldn't hurt to take them.

Thanks for the info on fat...I'll mention to doctor.  He is says the high fat diet caused fatty liver.

I have seen a family doctor as am mostly seeing a hematologist.oncologist as he is monitoriing my iron levels and many other vitamins as well as liver function.  He is the one who diagnosed fatty liver.  I saw an endocrinologist years ago but she didn't seem to know much about bypass patients.  Haven't seen my surgeon in about 1 year.  I suppose I should him and/or a nutritionalist specializing in bypass surgery.  Overdo for that.

Thanks for your response and advise!

If anyone wants to email directly feel free to:  ckassin@yahoo.com.

Darlin'; you've got something serious going on---and I think the doctors you're seeing don't have a clue about it.

You need to find yourself a seriously good bariatric physician. Not necessarily a bariatric SURGEON---you don't need someone to cut and sew, you need someone who understands the post-op physiology of the DS. Sadly, VERY FEW physicians do. And you DO NOT NEED someone specializing in"bypass" surgery---typically, "bypass" refers to the RNY/gastric bypass, which bears little or no resemblance to the DS. Certainly our post-op needs are VERY different.

90 grams of protein is really on the low side for any DSer. Most of us eat a minimum of 125, on up to 200 grams a day. Do you know your common channel length?

I seriously doubt you actually have fatty liver disease. I think you need better testing. Unless you're sitting eating lard with a spoon, it's rather hard for a DSer to consume, consistantly, too much fat. You MAY be eating too much of the wrong kinds of fat---but again, that's highly problemamatic.

Again---WHO is your surgeon? People here may be able to help you understanding your surgeon's post-op protocol. Just because someone's a good surgeon does NOT mean he or she knows diddley about post-DS nutrition.

 
I know...I'm already worried and getting more worried.  My fault.  Should have stayed on top of things more.  just because I felt great and strong doesn't mean i could ignore the rules.

Since I haven't seen the surgeon in ages...I think the first step will be to see him.  Or a nutritionalist specializing in DS patients.  I agree..a lot of doctors know very little about things.

No one ever mentioned that I need to consume that much protein.  Others  have recommended shakes.  Do most take shakes?

They told me the CT scan reflected early stages of fatty liver disease.  They checked into it due to elevated liver enzymes.

I was thinking it was because I was eating most anything...fried food, gravy, sauces, chips...etc.  Butter, mayo...all that kind of thing.  Little whole grains.  I did eat my share of lean meat too though.

The surgeon was Marek Lutryzkowski, Bloomfield Hills, MI

I don't remember common channel length now...I do remember he took...if I remember correctly 16-18" out of me.  

Thanks for all your advice, insight and help with this....
Cheryl

I don't remember common channel length now...I do remember he took...if I remember correctly 16-18" out of me. 


 Cheryl- 
No small intestine is removed with the DS.. It is simply rerouted.

I suppose I should him and/or a nutritionalist specializing in bypass surgery.

Why would you see a nutritionist specializing in bypass surgery when you have a duodenal switch? You're just going to get more wrong information that way. Dietitians/nutritionists just can't wrap their brains around the dietary requirements for DSer's. We should all thank G-d for each other on this board..it's the only way many of us would be able to stay halfway healthy! If not for the DS vets on this board, I would have been a nutritional trainwreck long ago. I'm dealing with some nutritional issues now that are purely my fault; the six months watching my Mom decline and die made me a little sloppy about taking care of myself.

I've got A, D, iron, calcium and protein issues this set of labs. I officially have osteopenia per my bone scan done earlier this year. I have been throwing all kinds of cal-mag-D supplememnts in, to try to get my parathyroids to go back to sleep! Of course I had calcium issues out of the gate, so that's been a constant battle.

For you, get back on your protein shakes, and never let them go! I decreased my intake from 4 a day to erratic consumption, and I'm in nutritional trouble. Not quite PPN or TPN, but I could be if it gets any worse! It's very easy for us to go from low normal to crisis once we get to the low end of the "normal" lab values.

I think I read that you had a 65cm common channel...mine's 75 cm...the shortest my surgeon does. Even more reason to get back with the program. Vitalady has a regimen for those with deficiencies, and those with shorter cc's are more prone to deficiencies.. make sure you get your vites in...and see about multivitamin infusion with your iron. I'm getting iron and multi infusion on Tuesday.

 Thank you so much for your advice.  Like you...due to a number of factors...I too was not careful in taking care of myself.  I have iron, D, Calcium and protein issues...but trying to get back to where I need to be.  I get iron infusions 2-3 times per year...6 doses at a time over a period of 6 days in 2 weeks.  Next due in Sept.  What do PPN and TPN mean?  I've seen Vitalady's regimen and printed it out.

Good luck with your infusions today...

 PPN-partial parenteral nutrition
TPN-total parenteral nutrition
This is when you are partially or totally fed via a tube attached to a port in your abdomen.

 Not a fun thing. Your meals come in the form of a liquid nutrition formula in a plastic bag, similar to an IV bag.

 I'm agreeing protein malnutrition.  You need to eat 100g of protein daily - and fat is a free food for us, and makes it much easier to get the protein down, too.

Hi Valerie...

Thanks for responding...

I'm guessing I eat 90g protein per day....will eat more.

Hoping to get to the bottom of this and I'm going to get protein levels checked most accurately for sure.

I would like to know your symptoms.

Hi Kayla,

I've lost additional weight after being steady for a while.  130 # for me is skinny.  I'm 5'6" tall.

Swollen ankles and legs...humid here so that is part of it.

Tired all the time...but low iron is part of it.

Bloated abdomen..I'm skinny everywhere except tummy

Diarrhia...though that has improved since I'be been eating more gains, cereal, salad and veggies

My main concern here is that this symptoms are also symptoms of pretty bad liver disease.  Kinda like which came first--you know?

How much protein do you eat?  How high are your liver enzymes?