Any signs that malabsorption has ended?

Just curious if there are any signs to look out for that your malabsorption has come to an end?  Obviously weight gain at the same calorie level may be a sign, but is there anything else to look out for?  Would there be any changes in the look of your bowel movments, for example? Anything else that anyone noticed around the time their malabsorption should ending?  (18-24 months, right?)

The process is very gradual, starting almost immediately after surgery, so you would not notice any difference even if there was one.  It isn't like you suddenly just stop malabsorbing calories at a certain point or over the course of just a couple of months.  The 18-24 month timeframe (and, as with everything, bodies are all different and some people will be outside of this on each side) is just the point at which the body has adapted as much as it can.  

The only physical "evidence" that people may notice (and, again, it is gradual) is that the amount of "rainbow" in the toilet when you have eaten a higher fat meal is smaller than it was very early out. 

Lora

This is exactly why I know I still malabsorb quite a bit, if I eat anything remotely fatty, which is super rare it is like an oil slick after I poop, you can see the shiny water.  Sorry for tmi but it is the truth, and it has never stopped since early out.  Thankfully I don't like fatty food or eat anything greasy as it makes me queasy so this is rare but I do notice it when it does happen.

I haven't yet run across any scientific literature indicating that this actually happens.  Yes, the ASBMS states it "may" happen in its post-op guidelines but I haven't seen a study or even heard of a plausible mechanism by which it could happen.

Yes - I've been saying this for a while also - and been excoriated for it on this website.  My surgeon does not believe that there is ever significant change in malabsorbiton of calories - and that any malabsobtion that occurs is small, if at all.  He and others (though not all) also agree that there is no mechanism to trigger any change as nothing has been removed from the digestive system, just bypassed.  Note that the malabsorbtion of vitamins never ends - the body cannot "adapt" or "regrow" this capability.

Processing of food into energy is a highly variable process that can be different from person to person.  While the package of a food may say how many calories of energy it can be converted to, some people (even without surgery) may not convert 100% - which explains why some people who are rail-thin can eat tons of fattening foods and never get fat, while other people can just look at a bagel and gain a bunch of weight.

A recent study from some researches at Mass General Hospital just showed this effect in mice - post RNY.  The mice that got RNY also developed helpful gut bacteria which may have allowed them to extract fewer calories from the same amount of food as normal mice.

NYT article on the study:

http://www.nytimes.com/2013/03/28/health/studies-focus-on-gut-bacteria-in-weight-loss.html?_r=0

The reasons for regain post RNY are still not understood, but research is being conducted.  Maybe this bacteria shift partially reverses in some people or maybe some never fully develop it - so they don't lose as much weight as others.

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.

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.

Honestly, I discussed that specifically with Dr. Lautz and he doesn't agree that it happens, nor has he seen any evidence of it while performing surgeries on people post-RNY.

As he now practices at the Mass General, I'm going to ask him if he is aware (or maybe participated in) the bacteria study and what his thoughts are on the subject.

The adaptation of the intestines is WELL documented in patients who have had the intestine removed for various reasons.  The only way the remaining intestine knows that something is missing is because the food reaches that portion of the intestine unprocessed by the upper portion of the intestine (and this is in people with intact stomachs).  The lower portion of the intestine recognizes this and lengthens the existing villi and grows additional ones to the extent that it is able in order to overcome the loss.  It is exactly the same in our system: the food arrives further down the intestine (and is in an EVEN MORE unprocessed state because it is not broken down by the stomach "juices"), the intestine recognizes the condition, and responds in the same way as it does when the uppermost intestine has been removed due to cancer or whatever.

Your surgeon can certainly look up the various studies on adaptation following intestinal removal and short bowel syndrome.  He probably should, in fact.

Lora

We discussed digestive adaptation in patients who have had their digestive systems resected.  Since nothing has been removed in RNY, there is noting to trigger it.

I will print out your posts and ask him about them when I visit with him next month.  I think he also monitors this website.

It is triggered by the very same thing as when the intestine has been removed... The remaining intestine recognizes that the food has not been processed by the previous portion of intestine.  It does not know whether it is from bypass or removal, and it doesn't matter why.  The body reacts to the situation the same in both cases.

Lora