Do RNYers stop malabsorbing after a while? Hope not!

On another board here, someone posted that "eight years post-rny we don't malabsorb calories" -- I have never, EVER read that (or heard it) anywhere else.

Holy cow, is that correct?

Yes, it's correct.  The malabsorption of macronutrients only lasts a couple of years.  It gradually goes away.

There are these little tiny things in your small intestine called villi.  They are like fingers that grab up calories and absorb them.  When they bypass part of the small intestine, suddenly there are fewer villi in there to suck up the calories.

However, your body quickly figures that out and it is afraid it's gonna starve.  So your small intestine starts to grow more villi in the part that has not been bypassed.  After two or three years, you have about the same number you had before surgery so you absorb about the same amount of calories again.

It's pretty cool if you think about it.

However.  We continue to malabsorb vitamins because only certain spots in the small intestine absorb each one of those.  That never goes away because some of those spots are bypassed forever.  Your intestine cannot grow new ones.

Kelly, surgeons should hire you as an information person! You provide such great explanations - better than most docs!

Oh, thank you!  I actually think that would be a really cool job.

I have heard that, though there is a mixed consensus over how much malabsorption we have to begin with, and what types of foods are malabsorbed, and how much we regain. The numbers that seem to me to be closest to fact (I've seen the most evidence via studies or other things I've read):

Directly postop RNY we malabsorb:
25 - 50% of all fat grams we consume
20 - 35% of all protein grams
10 - 25% of all COMPLEX carbs
We absorb 100% of the simple pure sugar type carbs.

Within a year we likely absorb nearly all of our complex carb grams, and most of the other grams.

BUT I've also heard that some folks guts are more successful than other guts, and there's also the fact of length bypassed. The more bypassed, the more "permanent" the malabsorption is. For example, I had 200 cm bypassed (close to 6 feet), and most have less than that, so I likely malabsorbed more than someone with only 100 cm bypassed. My guess is that I probably will have up to 10% malabsorption for life on fat and proteins, but this is a hard one to prove anyway. I think this is why we always count total calories, regardless of the fact that we do malabsorp some of them.

I know that up until about 3 years postop whenever I had a more fatty meal than usual, there was something like an "oil slick" in the toilet bowl.... malabsorbed fats. Now? No such luck.

I still get that oil slick, 10 years post op. Of course, I don't have my gall bladder anymore so that probably contributes to it.

 Well, this is a pretty interesting how-do-you do!

Here I am almost five years out, and struggling -- I can eat a cup of non-slider foods at a sitting, not malabsorbing anything ... and gradually regaining.

Sh*t.

I still have lost a great deal of weight and kept almost every bit of it off ... but now it's apparently like being a regular non-surgeried person except I have to take a lot of vitamins)????

Grrrrrrrrrr

Point of interest == after my colonoscopy last year, the doctor reported that I had a longer-than-usual colon.  Wonder if that happened before - or AFTER - the WLS!

Lisa

I don't think your WLS would affect the length of your colon.  Your colon is your large intestine, or bowel.  RNY bypasses part of your small intestine, the part furthest away from your colon.

And it's not like being a regular non-surgical person.  A regular non-surgical person has a stomach the size of a football.  You have a small pouch.  A non-surgical person can eat much more than one cup  of food at a time.

I didn't know this and researched RNY in length prior to surgery but hadn't come to this site and see it posted often by the veteran's.  It is funny because I have one friend that made it almost halfway to goal and another that was the leader of a support group that did make below goal and then gained about half the weight back.  I went home after talking to them both on the same day and told my family that I thought the intestine must compensate after awhile and perhaps regro villi.  Then I read it on here and confirmed what I thought.  I called both of them and neither knew that.

The sad story is for those that do so well (it's hard work) and then regain the weight.  They have had major surgery that has changed the digestive system and stopped using the tool after all this effort.  Not only is malabsorption largely lost at this point but they have set themselves up to need extra vitamins for the rest of their life since that does not change. 

This is one reason the OH forum is so good.  It fills in the gaps of what we know and don't know.  And, I thought I knew everything since I have so many friends that have had this surgery going back to 1991.  A couple are nurses and one is a Dr.    I shared this particular thread with several of my RNY friends when it came up a few weeks ago and the only ones that knew this are the 3 in the medical field.  However, they did not know it when they had RNY twenty plus years ago. 

Even though I'm struggling with regain a bit, I think that VERY FEW people regain a SUBSTANTIAL amount who follow the rules and have no physical malfunction of their pouch (stretched stoma, and all bets are off). If you do protein forward meals, never drink with meals or for half an hour afterwards, and if you modify your intake and exercise rate (my issue at the moment) like any normal person so that the two are at balance, you won't be able to regain a significant amount of your weight. If you consistently consume more calories than your body burns and never do anything about it, then YES you will regain. But ultimately, if you, say, eat 1600 calories daily, and your body needs 1500 you'll regain until you've increased to the point where the extra mass you have burns that extra 100 calories per day, and then you have a balance point. Maintenance is all bout finding a balance. Right now, I'm having an issue with that and I'm regaining. (I'm fluctuating between 3 to 14 pounds over optimum)

My plan is to increase my calorie usage and try to decrease my calorie consumption. It's a hard thing to do (as it is for most Americans) and ultimately I might find that I just balance out at a size 12 pants and give up trying to be a size 10. I'm not READY to give up, but I might havce to. (not because 10 is impossible, but because it's impossible given the amount of effort I'm willing to put into it.)

I did buy a couple of delighful dresses for several vacations this coming winter, and there's no way I won't fit them come the time. So if I have to start exercising, i mean REAL exercise to make it happen, then I will.