RNY er 's & absorption

vitalady
on 9/4/07 12:48 pm - Puyallup, WA
RNY on 10/05/94
What amount of what? I know that some docs (including my own at one point) thought that as time went on, the intestine would grow to make up for what was bypassed and therefore we'd absorb more and more calories and nutrition. He thought the need for supplementation would become less and less over time.

Well. He was wrong. For example, I started on 1600 IU of vit D per day i***** Today, I take 30,000 per day and two of the 50,000 per week to hold stellar levels. I have a distal, true, but after 5 yrs, I don't see much difference between us and proximals.

The only difference I see is in the protein, really. Proximals seem to get by on less over all. Oddly, the labs I see on proxies at 5-6-8 yrs out show the albumin consistently below 4.0 and protein usually up around 7.0. For distals like me, my protein is saggy at 6.4 or so, but my albumin is consistently up around 4.5 I'm assuming that's because I take a lot of protein.

Iron is depeted by all of us. But my dh and I are both holding stellar levels on oral iron, but we take a lot of it. Proxies at 5 yrs are often on infusions because they were not started on orals until they were in the toilet.

So, that doesn't tell us a lot, because some of the issues MIGHT have been addressed early on, if the proxy had supplemented properly. (Proper by whose standards, I know).

Nothin absorbs in the stomach except SUGAR and alcohol. Stomachs digest. Since our food doesn't go there, we are not digesting in any normal sense. No matter if we are proxy, distal or BPD-family, the duodenum is bypassedin all of us. It's thicker, wider, has more "fingers" and is the most absorptive part of the intestine. IF it receives DIGESTED food and IF the food goes there.

None of that happens. THE food goes into the pouch wrapped in some saliva, then on down the shoot (middle of intestine) undigested. The digestive juices and enzymes go on down the old route, the duodenum, and they eventually meet up at the junction of our Y. This never changes.

The tail of the Y is called the common channel. As a radical distal, mine is very short, and proximals have a longer one. Still, it is the WRONG END of the intestine to do an efficient job of absorbing non-digested foods, tho over time, it will try its best to BECOME that missing duodenum. It grows longer, thicker, wider, grows more fingers. Hypertrophy (opposite of atrophy)

And docs are counting on that to make us "normal" again after a few years.

But the ileum (far end of the intestine) does not REALLY become a duodenum, so while we get more calories (every mistake counts bigger over time), the need to supplement these vitamins becomes more critical, since the clock is ticking on how long since we HAVE been able to get them from food.
protein
iron
calcium
A, D, E
B1
B6
B12
zinc

And who knows what else? These are all I know and it's a few more than they speak about at the ASBS, as yet.

So, to answer your question, from MY point of view, we will become mroe efficient at absorbing carbs and empty calories because the flimsy end of the intestine will become good at that. We will need MORE supplementation to maintain the levels of the list I just gave you.

So, labs should be at least every 6 months, FOR LIFE, and should include, at the very least, the things I listed. And YOU should have them and YOU should make a spread sheet, starting with your pre-op labs. And YOU will see the numbers for yourself and no one can "sell" you on any concept, because you will have your own black and white proof in front of your very own eyes.

My docs think our spreadsheets are very cool. While they are mainly interested in their particular group, they are curious as to how we fare as long term distal RNY's. And hey, why aren't we sick, like the books all day, anyway?


I know there are docs who do not believe in malabsorption, either right up front or certainly after a few years, but I'm here to tell you, they simply stopped running labs or they'd know that is very much not the case. As I point out often, the yahoo grad list has years of info, so it's not just me. Look at all of THEM and draw your conclusions.

Medical facts? There simply is not much on malsorption. Period. It's not a field that actually exists.

You can probably find something on intestinal hypertrophy, as well as other types. For example, it was noted in heart bypasses that their bodies often created OTHER vessels to supply blood to the heart in an attempt to normalize what "man" did to it. Fascinating stuff.

Michelle
RNY, distal, 10/5/94 

P.S.  My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.

Tracy B
on 9/4/07 1:12 pm - Erie, PA

Michelle, I knew you'd have some good thoughts on this so I was checking back to see if you replied. You just know SO much and you can break it down into things that I can clearly understand, so Thanks!

~*~Tracy B~*~

328/160 *** 5'9"
start/current

vitalady
on 9/4/07 1:21 pm - Puyallup, WA
RNY on 10/05/94
Whew. Thanks!

I get so deep inside my head and see the word pictures and *I* know what I mean. After I hit send, then I see the typos and maybe incomplete thoughts, cuz *I* knew what I meant! LOL

I really CAN spell and grammicate, but I CANNOT TYPE!

Michelle
RNY, distal, 10/5/94 

P.S.  My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.

ShirleyG
on 9/4/07 8:27 pm - HALFWAY BETWEEN ATLANTA AND BHAM , AL
Thanks Michelle , I was looking for the amount of calories or fat that proximal surgery people absorb and YEAH TO YOU :0 you gave a better answer than my doc's .  I have taken my vitamins , calcium and b-12 sublinguel from day one ...  I am 4 years out in November and all my labs are perfect every time so far . Thanks so much for yours and all the other responses.  I knew there was some smart folks on the board .. Thanks again  Shirl
vitalady
on 9/5/07 9:32 am - Puyallup, WA
RNY on 10/05/94
I'm thinking if that's all you're taking and your labs are perfect that A) you're not getting all the labs and B) you're not getting copies for yourself.

I have a very unpopular virew of calories. While we've been taught and most medical ppl believe that is calorie is a calories, I see no reason to perpetuate that myth. Calories were invented in 1926. The amount of time it took to burn a piece of food in a special oven. Just how special WAS that oven back in 1926? And what precisely does that oven then have to do with me today?

And why was I gaining wt on nothing but salads, but had a friend who ate bananas and milk with every single meal and could not reach up to 100#?

So, I ponder that not all bodies burn anything at the same pre-determined rate. So, when I see ppl posting their cal per hour doing XXX thing, I wonder just whose body that was set for. Not THIS body, since I couldn't burn a calorie with a blowtorch!

Prt of the disease of morbid obesity is that we don't BURN calories, we STORE them, particularly from carbs, which is why sugar (and alcohol) are so deadly to our wt loss.

I KNOW I can drink as many as 9 protein drinks per day (30g each, around 180 cal each) and lose wt. If I eat 300 cal of sugar, I will gain. So simple.

So, generic calories? I cannot tell you. With SUGAR, you get 100%, for life. In fact, I suspect we get MORE than 100%, since even thinking longingly about fudge makes my waistband snug.

Fats? Maybe 10% for my distal or a BPD or DS and maybe 30% for you? If more, you would not have to think about your vites A, D & E. And sooner or later, you WILL Have to think about them.

Protein, 10% of food for me, maybe as much as 30% for you?

So, there is my very unpopular opinion on calories. it's not likely to change, either.

Michelle
RNY, distal, 10/5/94 

P.S.  My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.

Ruby R.
on 9/4/07 9:18 pm
Michelle, thanks for the reply.  When I see you have replied, I always read.  thanks for being there. Patricia
(deactivated member)
on 9/4/07 11:15 pm
I'm glad you're here. I will drive you crazy the next couple of years asking questions.
vitalady
on 9/5/07 9:20 am - Puyallup, WA
RNY on 10/05/94
LOL!

How do you think I learned this stuff? I sucked braiins out of my docs and when they were empty, I sucked other brains.

Ppl run when they see me coming! LOL!

Especially nutrition ppl. Well, you gotta live with a pouch to know how to drive one, I always say.

Michelle
RNY, distal, 10/5/94 

P.S.  My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.

Vickie J
on 9/6/07 2:30 am - Tallahassee, FL
Michelle, Thank you so much for your post!  Your reply explains it in a way that makes sense to me.   I have the "usual" labs done at least twice a year (CBC w/differential, Complete Metabolic Panel, Lipids, and B-12) and a "full battery" of labs (the usual + PTH - Intact, B-1, B-6, Vit. A , and Vit-D 25-Hydroxy, D2+D3) done once a year.  My labs are usually very good but this last time my Cholesterol, LDL, and 2 liver enzymes (SGPT & Alka Phos) were elevated  and I don't know why.  I am eating more carbs than I used to but I'm over 2 1/2 years out so I would think that isn't the problem.  My pcp isn't too concerned but he is going to re-do the labs in 3 months to see if they're still elevated.  If they are he said he may want to put me back on meds.  I really don't want to go back on meds if I can help it.  Got any suggestions?  I already supplement with a bariatric multi-vitamin, iron, B-12 sublingual, calcium citrate w/ Vit. D & Magnesium, Zinc, Vit. K, Biotin and Omega-3 Fish Oil capsules (I don't eat seafood) and I take a prescription Potassium b/c it was running low early post-op. I also question how much we absorb / malabsorb medications.  Should our docs increase the doseage or dose more frequently for things like antibiotics, decongestant / antihistamine, cough / bronchitis / asthma meds, etc?  Enquiring minds want to know!! Thanks for taking the time to research this and pass along your knowledge!! Vickie J.

Vickie J. 
"Most dreams are lost by giving up what we want most for what we want at the moment."

vitalady
on 9/6/07 11:18 am - Puyallup, WA
RNY on 10/05/94
That's a lot of questions! OK, i don't know why a fw of us go back to bad lipids. I'm thinking it's family, cuz it's not likely you suddenly started abosbring fats or oils.

Which brings me to the fish oil caps. Waste of$$$, IMHO, since you are not getting much. If you want OMegas, use Coromega. I tested it in my own distal blood before standing behind it.

Elevated liver enzymes are not explained, but are not uncommon among us. Most of us take milk thistle and if they are only slightly elevated, that usually does the trick. If they are very high, of course, more tests need to be done since liver disease can really happen. It's just that with US, we usually try the simple approach first.

Like elevated PTH levels. some docs have our ppl schedule for surgery to kill off some of the PTH without even checking vit D levels first! EGAD! We can usually fix that by raising D levels. If it doesn't change in 3 months, schedule CT, MRI, whatever, but dang, don't go ripping a hole in someone based on ONE lab result, you know?

One of our local ppl was done such, so I had more input (than I'd put in writing! LOL) and INSISTED with my foot stomping and fire coming out of my nostrils that she get a 2nd opinion. Whew. That doc recognized secondary hyperparathyroidism as a side effect of WLS, and low vit D. We fixed her D, PTH fixed itself, and she was spared a totally unnecessary surgery.

Michelle
RNY, distal, 10/5/94 

P.S.  My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.

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