living with the duodenal switch

Living With the Duodenal Switch (DS)

June 6, 2016

At 49 years old—nearly 200 pounds overweight, with autoimmune diseases including Chronic Fatigue Syndrome, Hashimoto's Thyroiditis, and Fibromyalgia—I was able to accomplish little beyond waking up and shuffling through the day before climbing back into bed. It was almost as though my life force was circling the drain and there was nothing I could do about it.

That was 2004—11 years before I made one of the top five wisest decisions of my life. One that brought enthusiasm, hopefulness, and a belief that life can change for the better even when all seems impossibly bleak. And while some of my chronic health issues remain, my ability to cope with them has changed in so many ways that I hadn't anticipated.

When I said my goodbyes as I was escorted to the operating room on November 19, 2004, I had no idea exactly where the Duodenal Switch surgery would take me. But hope, faith, determination, and love served us miraculously well.

I am one of those living breathing miracles that the DS embodies.

Researching the Duodenal Switch Procedure

During my first meeting with Dr. Mitchell Roslin to discuss having weight loss surgery, even he would have categorized me as the stereotypical aging woman opting for the surgery instead of heading for lipo(suction). No matter how I tried to impress upon him that 40 years of (literally) gaining and losing a half ton of weight had taken its toll and this was my "last resort." (I could no longer lose and gain 100 pounds by sheer willpower; my thyroid basically stopped cooperating up with my extreme yo-yo dieting.) He was not anxious to give me the Biliopancreatic Division with Duodenal Switch (BPS-DS, most commonly known as the DS) because of concerns about malabsorption in an older woman ("If you were in your twenties, I'd say no problem but calcium absorption especially can be such a problem at your age"). Of course, that was then, and this is now, but I do believe that my actions, success, and those of his other DS patients around at that time—

Of course, that was then, and this is now, but I do believe that my actions, success, and those of his other DS patients around at that time—and since—finally convinced "Doc Rockstar" (as I call him) that the DS really is a more optimal procedure. In fact, he has shared this globally at bariatric conferences and seminars.

For all the sometimes heated debates encountered back in 2004, those of us who were fortunate enough to find a surgeon competent in the DS procedure—and who still had the fight left in us to hold out and make it happen with our health insurance companies—most of us who had our DS have been too busy moving forward to look back. I had to create a 369-page binder full of personal information and research data, to countermand claims by my insurance company of it being an "experimental procedure" before they finally acquiesced.

I truly was thinking about those of you who would come after me when I held my ground. To me, it was not just my life and peace of mind, it was standing up for others who did not have the resources to make a statement that could change lives for the better. There was a virtual team of us who supported each other to make sure these documents were shared and the word got out not to take "no" for an answer.

Probably a more liberal allowance of fat intake is one of the better food-related benefits of the DS with conscious monitoring of simple carbohydrates (e.g., sugar, white flour products, etc.). Dr. Michel Gagner determined in his significant research that malabsorption of fat continues indefinitely post-DS at a rate of approximately 80%, which also considerably improves health stats such as cholesterol level and blood pressure.

Complex carbs (e.g., vegetables, whole grains, and fruits—in that order) can be carefully integrated into the diet, always taking a back seat to protein intake. Concentrating on protein is twofold: Absorption of protein can be as low as 50% immediately after malabsorption weight loss surgeries and it aids healing, keeping muscle mass intact while still allowing for loss of fat.

Living With the Duodenal Switch

There is greater post-op satisfaction with the DS because patients do not commonly "dump" (feel nauseous, fatigued or otherwise physically affected after overindulging in simple carbohydrates), especially when in the weight loss phase.

The DS simply allows for more "freedom of movement" in food choices; the urge to "cheat" is greatly reduced because nothing is really forbidden and there are limits to how much one can ingest.

Unique to this aspect, I do feel particularly tired and/or nauseated if I have too much sugar or white flour on an empty stomach. I thought this would be a minus but the fact that I have never really "stretched my belly" post-op is such a plus, I take it as the wonderful reminder it is to "proceed with caution."

Variables post-op include each individual's pre-existing health conditions and how their bodies adjust to the "rerouting of their innards." (Yes, it's time to go there. Let's face it. It's probably why you're still reading…) Plain and simple: Pre-surgery I was not a person with clockwork potty habits; I maintained then—and believe I've since proven—that I was not wired well in that regard. I absorbed everything I ingested and my body held onto it. Hence, the toxins that created the autoimmune disease. I now eliminate like a perfectly healthy person and my weight is normal. Yes, there is a distinctive "fragrance" and a sense of urgency if I've ingested too big a portion of simple carbohydrates—especially accompanied with a higher fat percentage (e.g., biscuits smothered in sausage gravy)—but make my selections in conjunction with convenience of access to "facilities" within an hour of doing so.

Initially post-op, my husband and I started traveling extensively and it allowed me to be open to people, places and things in a way that turned the "How fat do I look?" bugaboos into a deeper love and acceptance of a world way beyond my own preoccupations.


My weight loss of nearly 175 lbs (321 highest to 126 lowest) was compromised by menopause and "normal people ups and downs" but attention to movement and protein, usually keep me within 15 pounds of my lowest post-op weight. At 5'7" and 60 years old, I consider myself blessed yet remain conscientious and vigilant about such things. But I no longer feel as though the world glares at me for eating an ice cream cone in public. No one looks at me (who doesn't know about my extreme weight history) and has a clue that my size 6 was once a size 26.

Most importantly, my surgery has allowed me to completely love—and believe in—myself and convince others that persistence and courage has its benefits. To positively impact, help, and affect others, without the issue of weight being a barrier. Freedom from being so far inside my head about how I looked and felt that I didn't get to embrace the universe for the wonder it is. A door opened that was so beyond my expectations that I wouldn't trade it for a lifetime of delicacies that wouldn't ever put on an ounce.



Melissa Mermaid is a spiritual consultant, writer/editor, and former journalist currently living in the New York City area. A self-described "professional multi-tasker," she has documented proof of losing and gaining a thousand pounds before having a Biliopancreatic Diversion with Duodenal Switch in November 2004.