You'd be quite thoroughly astonished to discover how many people get surgery without knowing even the absolute basics: Your stomach is mostly removed but you don't have a pouch. Your small intestine gets divided approximately in half and made into two limbs that meet at the bottom.

You only absorb about half the protein and 20% of the fat you eat. Therefore you must eat at least twice the RDA of protein every day in order not to risk protein malnutrition. 100 grams of protein from food is xyz amount of food in a day. Carby foods are not that good for you and can give you a bellyache and the farts.

You have to drink a LOT of fluids, at least 64 oz. per day.Learn how much that is (hint: two quarts, or two large fastfood drink containers). You HAVE to take a basic batch of vitamins containing abcd. You HAVE to get lab work done.

These, to me, are bottom line minimums. If you can't figure that much out, you need to not have a DS.

I think perhaps an easier battle would be getting surgeons and nutritionists to start off by giving accurate information.

My surgeons nutritionist gives standard rny info. I happened to be in the same nutritional group session as Jonathanac and 2 or 3 other people. The nutritionist asked questions like what is a calorie (and when I said a unit of heat that wasnt the answer she was looking for lol) and then held up pictures from a book that she probably took out of a kindergarten classroom with pictures of foods. I don't remember the exampled but it was something like a porterhouse steak or 8 baked potatoes with salsa. I just smiled and nodded my way because I wanted to get out of there but Jon mentioned with the DS about being able to eat fats and the nutritionist started fuming. She insisted that with the DS we cannot eat that much fat, when he mentioned the malabsorption study she told him that she will discuss it with him during their one on one consult (aka see me after class). I don't know if I was more pissed off to see the nutritionist, who has probably never been fat a day in her life behave that way or the people who sat in that class completely fascinated by the side by side pictures of a bowl of pasta or 12 oranges and had no clue how to read a label yet were about to get wls.

Unfortunately more studies need to be done. I know my surgeon is doing one and had some forms for us to fill out if we wanted to participate but I think thats just to look at weight loss from the DS compared to other procedures. I would love to participate in a study that examines our malabsorption.

When I was going in for my second visit with my surgeon I med a DSer who was about 6 months postop in the waiting room. She was really sweet and we chatted for a while. She didn't know about OH but I suggested she check it out. No idea if she ever did but I asked her about her diet and what she was eating. She was following the nutritionists advice word for word. She took some iron, adek, multi and calcium as her vites and followed a strict low fat diet consisting of protein shakes (made with water), baked potatoes, skinless chicken thighs, baked white fish with lemon juice and salsa etc. When I tried to gently suggest increasing the fat and adding more vites she got pretty offended and insisted that she was doing everything right. Ummm okay, whatever.

People are sheeple... most people arent inquisitive or proactive but thrive when they are micromanaged and can do as they are told as long as it isnt too complicated or intrusive. I think if we start with having nutritionists giving out better advice on food and supplements that would be a huge step.

I know my surgeon is selective when he performs the DS and he told me he would consider it to be akin to malpractice if he performed the DS on someone he felt didn't fully understand the procedure or have what it takes to be compliant and he will recommend the sleeve to those people but when compliance starts with following rny dietary advice and taking some BA adek, its problematic.

Yes yes yes! I want to find a way to communicate something TO THE PROFESSIONALS about changing what they do in the way of education and patient selection. THAT'S what I was thinking when I started this thread. There is minimal literature out there about the malabsorption, supplements, diet etc., and basically ZERO about mental status and relative intelligence or educability of patients and success rates. (This is, after all, a field in its infancy.)

So, how could we team up as a community to put our OWN information together in a presentable fashion? Note presentable to PROFESSIONALS, not to consumers.

Have you read good calories bad calories by Gary Taubes?
It isnt about wls but low carb dieting in general, its a fascinating book and very well written imo. There isnt much published info on the DS but there is an increasing amount of info available on high fat low carb dieting in general. Perhaps getting the nutritionists away from the fat phobia in general might be a decent starting point. That combined with our malabsorption of fat should be an even stronger case as to why a high fat diet is beneficial for DSers.

I know what you mean! I'm not all that surprised though. The DS doesn't have the market cornered on ill-informed patients, though. ;) People have elective surgeries all the time without fully knowing the risks and possible outcomes that could arise.

This was my take on it, if you don;t "GET" these point DON'T HAVE THE SURGERY!

http://www.dsfacts.com/required-commitment-for-duodenal-swit ch-surgery.html

Total open to suggestions btw!!

Required Commitment for Duodenal Switch Surgery

There is a required commitment for Duodenal Switch surgery. Duodenal Switch is a fantastic weight loss surgery option with the highest documented results in long term excess weight loss maintenance. [51] However, the success for the patient does not end with the surgery alone. To maintain proper health patients are required to take vitamin and mineral supplements daily, have their blood work checked yearly at minimum, have bone density scans every year or two and consume about 100 g of protein a day. Some surgeons require patients to attend weekly or monthly support group meetings as part of post-op follow-up to ensure patients remember the commitment they agreed to before having surgery and the seriousness and consequences of non-compliance.

Required Commitment for All DS Patients:

1) You MUST take your vitamin and mineral supplements DAILY.
2) You MUST have blood labs drawn semi-annually or annually to check your levels and to adjust your supplements accordingly.
3) You MUST have a bone density scan done every year or two years to ensure that a good calcium blood level is not the result of your body leaching calcium from your bones.
4) You MUST consume approx 100 g of protein every day, either through food or protein supplements.

DO NOT HAVE DUODENAL SWITCH SURGERY IF YOU CAN'T COMMIT TO THE 4 ABOVE POINTS, FOR LIFE. THEY ARE NOT OPTIONAL.

If you choose to ignore the 4 points above you WILL get very sick and can suffer IRREVERSABLE damage to your body.

The information that follows on deficiencies happens. There are post-op weight loss surgery patients (this is not uniqe to DS and includes RNY patients) who lost all their teeth due to calcium and vitamin D non-compliance and others developed osteoporosis. There are patients who have permanent vision impairment and balance issues due to ignoring B1 deficiencies. There are patients that ignored B12 deficiencies and suffer very serious neurological impairment. You can't ignore your vitamins, THEY ARE NOT OPTIONAL.

5) You MUST consume  a minimum of 64 oz. of water/fluids every day.

DO NOT HAVE DUODENAL SWITCH SURGERY IF YOU CAN'T COMMIT TO THE 5 ABOVE POINTS, FOR LIFE. THEY ARE NOT OPTIONAL.

If you choose to ignore the 5 points above you WILL get very sick and can suffer IRREVERSABLE damage to your body.


I would add this one to the list. I'm preop and i'm having a hell of a time doing it, lol- but i am!

Excellent :-). Hear hear for point #5 too.