I'm just curious which DS surgeon you spoke with, Keshishian or Crookes?


I know you have a sleeve, but try to imagine that you have a pouch instead. So you have a pouch that needs to be filled in order to feel full, but you also have a blind stomach that produces ghrelin. So as you fill your pouch your blind stomach is producing ghrelin, and so you never feel full. Imagine your pouch being full, yet you are still manufacturing the hunger hormone like crazy. This is why RNYers complain of having an endless pouch. They can fill it, even stuff it, but that ghrelin hormone makes it so they never feel satiety. I guess this is what the surgeon you spoke to was referring to as two seperate hunger signals, the pouch and blind stomach.

But again, there is also the metabolic factor as well. The RNY has a very mild and temporary effect on metabolism as is its effect on satiety mild and temporary (in comparison to the DS).

I spoke with Dr K

So how would that theory work for the lap band, being that the lower stomach is not " blind "?

That isn't really how it works though. Ghrelin isn't produced willy nilly. It's produced in response to our eating. Pre-op most of us produced way too much ghrelin, much more than a normal weighted person. Post-op most of us don't have that much ghrelin.

I know we all love our VSGs and our DSes but you guys act like no one experiences hunger control with any other surgery and that's not true. From what I've seen on the boards and what I know about the science, I do think hunger control is more of a "sure thing" with DS and VSG because removing the part of the stomach that makes ghrelin makes it much harder to produce it in large quantities (it's still made in the intestines so it's not like we don't have any).

But, as was said by someone else, more than ghrelin is involved. It's the hormone we understand the best but there are other factors. That's why band patients can have hunger control even though one study showed them having 2x the ghrelin as pre-op.

Scientists haven't quite figured out how all this stuff works but they currently believe that when our pouches/pre-stomaches/sleeves stretch out when we eat, this sends a signal up the vagus nerve that tells our brain we are full. All the surgeries have that mechanism no matter what it going on with ghrelin.

 The VSG also changes our insulin response to food.

There are a few things I would like to tell you.  First, visit the Revisions board.  Second, "with a grain of salt" look at the surgery dates of the people replying.  Some of them are in the 'weight-loss' window, or the 'honeymoon' phase.  Look at the replies from people who are further out from surgery and have lived with it for over 3 years.  Wisdom comes from time lived with weight loss surgery.

I can honestly say the with the RNY over 9 1/2 years ago, I have been looking into a revision to the DS.  Even though I have maintained 50% of my initial weight loss (gained up to 230, but now sitting at right below 250).......................... I am "STILL" considered a "success".


Good luck on your journey!!!!!
-Jamie in Alaska

I won't even pretend I know 'how' my DS fixed my metabolism---I just know it DID.

Today, nearly 8 years post-DS, I eat 2500-3000 calories a day, but only absorb a little better than half of them---let's say 1700 or so. On that amount, I'm maintaining a loss of 170 pounds, effortlessly. Pre-op, 1700 calories a day was not only MAINTAINING my current weight PLUS those 170 pounds, I was slowly gaining.

But I do take pills four times a day. MUCH easier than it was restricting myself to eating only 1700 calories. (*grin*)

Read this paper, in particular the Discussion: http://files.meetup.com/379062/DUODENAL%20SWITCH%20LONG-TERM %20RESULTS.pdf

The same principle investigator wrote this, which relates to the BPD, but the same exact metabolic mechanism is behind the DS, only with fewer side effects (because the stomach portion of the surgery is far superior):

Obes Surg. 2005 Jan;15(1):3-10.

Contribution of bariatric surgery to the comprehension of morbid obesity.

Marceau P.

Source

Laval Hospital, Quebec, Canada. picard.marceau@chg.ulaval.ca

Abstract

Convinced that morbid obesity was not due to food excess but rather to a metabolic disorder, we searched in the literature for data in favor of a metabolic disorder. We have found evidence in support of the thesis that the cause of morbid obesity is the inability to burn excessive caloric intake normally. It would involve the difficulty to increase heat with the amount of calories taken, which would be faulty and force fat deposition. This mechanism called dietinduced thermogenesis (DIT) allows the dispersion by heat of excessive calories to obtain energy balance. Results from bariatric surgery and particularly biliopancreatic diversion (BPD) give further support to this thesis. BPD would improve heat production to a meal (DIT) by one of these mechanisms: increased insulin sensitivity, change in intestinal hormone secretion, or chronic lipid malabsorption. Available results show that surgery, to be efficient, must change the physiology and not solely decrease food intake.

I don't DIET, I eat healthy.  I eat A LOT of carbs, but they are complex not simple.  I eat oatmeal and quinoa daily which really ups my carb count, as does the few pieces of fruit I eat a day.  

I get in over 120 grams of protein a day but it's not unusual for me to get in over 200 grams of carbs a day also.  I don'****ch fat but I don't fry anything either, it's either baked or poached. I eat full fat cheese and low/no fat yogurt.

i eat in excess of 2000 calories a day, generally it's 2500.  BUT I love to exercise and typically burn about 2000 calories  from exercise daily and I'm maintaining with this lifestyle.  If I was to decrease my exercise I would drop my calories and carbs as well.

I won't lie, I do occasionally have cheat days, where I'll eat a burger or a slice of pizza.  And for me it's a good thing, as I satisfy my craving and I'm done with it.  The added plus is that I have a FANTASTIC bowel movement the next day and I drop a couple of pounds!  LOL

And your surgery was when?  All of 18 months ago roughly?  You do understand that your malabsorption is going to end in the next 18 months, right?

~Becky

My surgeon said that malabsorption would end around 18 months out.  So I am going on the assumption that mine has ended already.

Given my current lifestyle my diet is appropriate for where I am right now.  If things were to change then I would adjust my diet accordingly as I stated in my post.