Controversial - Ghrelin is actually a GOOD thing!

No, that is not correct.  I know it intuitively may seem that way, so I don't mean to sound critical, but the now proven fact is that proximal RNY does not produce any significant caloric malabsorption (likewise re the insert example). 

The reason that there is no malabsorption is that the later parts of the small intestine are more than up to the task of absorbing the extra calories they will receive (though maybe not 100% of nutrients) after the duodenum is bypassed.  And by receiving these packets of calories (as would occur to some degree with healthy, thin people - but not the morbidly obese / diabetic), the parts of the small intestine that are downstream of duodenum perform their proper hormonal and physiological signaling, and THIS is a big-hitter as to why RNY cures not only obesity, but diabetes and the constellation of associated metabolic disorder (high blood pressure, high cholesterol, high triglycerides, etc).  And as noted, RNY also addresses the homeostasis via controlling hunger, satiety signalling, and pleasure responses, further adding to its efficacy in long term weight reduction.

Malabsorption simply has nothing to do with proximal RNY weight loss results, and people need to try to get the message out to surgeons and bariatric centers so prospective patients will stop being taught that malabsorption is the difference between RNY and VSG surgery when it comes to weight loss.

My surgeon also confirmed the fact that mal-absorption is only about 10% of the effectiveness of the rny procedure short term and stops at about 8 months. She also said that she has been removing the stomachs and the duodenums in revisions to RNY patients that gain all their weight back after having lost it in the first two years.  This is what she decided to do for me because she said that there are hormones that the stomach manufacture that have lots to do with weight gain. I wonder if this is the ghrelin.

The studies do not even support 10% (way too generous), but at least your surgeon is headed in the right direction on that.  Good luck with the revision -- I can't speak to the more radical removal of the stomach, as I thought that was necessary for its digestive juices (hence the 'Y' in Roux-En-Y for where digestion juices and food rejoin further down in small intestine).  But much success to you.

I know it. I am a little freaked out about this decision of hers but I am trusting her. She has amazing credentials so I feel safe albeit somewhat apprehensive. She told me that the mal absorbsion is 10% initially only and not a factor in the weight loss. I was told that the loss of appetite is the biggest boon to the weight loss however several people in my support group said they were constantly hungry since 5 minutes after waking up after surgery. I am just hoping to be  off dieting....dieting hasn't done anything for me. I became obese after my hip went out and I was in a wheel chair for 2 years.  The lack of activity and the amount of food I was eating didn't match and I gained 75 lbs. once that gain was in place i have kept it up since and gained 10 pounds a year....No diet or lap-band worked.  I really hope to have the RNY success so many on the boards do.

I just had surgery with Dr. Blackstone 6 weeks ago and she never mentioned she is now removing the unused stomach and duodenum. When did she start doing this? Is this for all patients of just revisions? I had RNY, not a revision.

To avoid confusion, I want to re-emphasize that the dramatic increase in energy expenditure (EE) seen after RNY (but not VSG) is in resting energy expenditure (resulting from hugely increased EE after eating but not fasting).  Again, I think that this fact is pretty significant.

So how would this apply to me. My BMR is 1636 calories. Would this go up or down.

Since this thread was meant to be about ghrelin, I think I will extract the discussion over RNY and malabsorption and start a new thread now -- "Controversial -- Malabsorption has NOTHING to do with proximal RNY weight loss!"