Dreamy
Why the DS instead of the RNY?
- The RNY bypasses the stomach, using an artificially created “pouch” to temporarily hold food before exiting to the intestines. The DS keeps food going through the actual stomach, but makes the stomach smaller instead. The stomach has natural muscles and a special valve that empties food into the intestines. Because the DS maintains these natural stomach muscles and the pyloric valve, food follows a more natural, controlled route. Therefore the DS avoids common RNY side-effects (most of the reasons people feel sick or need to vomit after eating) such as:
· Dumping. This is caused by certain foods passing too quickly into the intestines. Usually sugar is the culprit, but this can happen with fats or other types of food—even sugar-free foods! It varies on what will make you dump and in what amounts. Some people do not dump at all, while other people can dump after eating as little as 5 grams of sugar! Can you commit to never being able to eat a little treat ever again?
· Food getting “stuck”. Fibrous foods like chicken, beef, lettuce, and raw vegetables can sometimes be difficult for people to eat after the RNY because they become lodged in the pouch with no ability for stomach muscles to help move the food through.
· The stoma (the exit hole from the pouch) getting stretched (which causes food to exit too quickly and thus the person to become hungry again too quickly.) This has become a common enough problem that new procedures have been invented to try to resize the pouch for RNYers who are always hungry with stretched-out stomas.
· Strictures. (The stoma becomes too narrow so that food can no longer pass through.) This problem requires another visit to the surgeon.
· The malabsorption of certain vitamins and minerals that rely on the pyloric section of the stomach to be absorbed: iron and vitamin B’s.
- The DS allows for more normal volumes of eating. Just like crash-dieting destroys your metabolism, the restricted eating following weight-loss surgery causes your body to adapt by requiring much fewer Calories to maintain your weight. (http://www.ncbi.nlm.nih.gov/pubmed/17658019?ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum ). Many RNY doctors recommend 1000 to 1200 Calories per day for the rest of your life after you reach your goal. (See http://www.dlife.com/dLife/do/ShowContent/food_and_nutrition/weight_management/post_surgery_diet_bariatric_patients.html “Most long term post-op bariatric patients find they need to limit their total caloric intake to less than 1,000 calories per day to maintain their weight-loss.”). Even if 1000 Calories can make you “full”, will it keep you “satisfied”? Being full and being satisfied are two different things. The malabsorption of the DS offsets the slow metabolism so that many DSers can easily eat 2000 Calories per day, like the recommended amount for “normal” people.
- The DS reduces ghrelin. Ghrelin is a hormone related to hunger cravings. The stomach is one of the biggest producers of this hormone. With the RNY, even though the stomach is bypassed, it is left inside you. This means that it will continue to pump out this hunger hormone. Since the DS trims the stomach to a smaller size and removes the rest, there is much less stomach tissue inside of you to produce this hormone. (Learn more from this study: http://cat.inist.fr/%3FaModele%3DafficheN&cpsidt%3D18283727?aModele=presentation .) The benefit is that even though you can eat more with the DS, you will find that you are often not even tempted to eat more. You will be satisfied much more easily, and junk food cravings are much less of a problem for many DSers.
- The average weight loss is greater and more easily maintained with the DS. While studies show the average excess weight loss for the RNY to be from 60 to 65 percent, the long-term studies (more than 10 years) show the RNY results to be closer to only 50% of excess weight lost (http://www.clinicianreviews.com/index.asp?page=8_199.xml ). This means that if you needed to lose 100 pounds in order to reach a normal BMI, the likelihood is that you will only be able to maintain about 50 lost pounds. If you need to lose 200 pounds, you will probably be able to maintain around 100. And 20 percent of RNYers completely fail. (http://ajpregu.physiology.org/cgi/content/full/293/4/R1474 ). That’s 1 out of every 5 patients! Some RNYers are able to maintain their weight loss through hard work and strict adherence to the Calorie restrictions. But the averages show the reality for most people. Will you be able to keep up the diet (which may be less than 1000 Calories) for the rest of your life? The DS, while not perfect, shows a much better average of 78% excess weight loss maintained in the long-term (18 years). (http://www.clinicianreviews.com/index.asp?page=8_199.xml .) And while some RNYers have actually regained all of their lost weight (and sometimes even more), this is virtually unheard of with the DS.
- Many of the “fears” associated with the DS are exaggerated, untrue, or exist with the RNY as well. The bowel issues? While many people hear that the DS might cause diarrhea, foul-smelling stools, and gas; it is too often ignored that these exact same side-effects exist with the RNY as well (in addition to chronic constipation). (This study found no significant differences between the bowel habits of DSers vs. RNYers: http://www.ncbi.nlm.nih.gov/pubmed/18752029?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum .) It varies from person to person, but avoiding the DS because of possible bowel side-effects could result in an RNY with the exact same problems in addition to all the other side-effects associated with the pouch.
Another fear is malabsorbtion. While the DS results in more overall malabsorption, the RNY completely bypasses important absorption sections of the gastro-intestinal system, actually resulting in worse malabsorption for some specific nutrients than with the DS. This study, for example, found no difference between the nutritional deficiencies of RNYers versus DSers except with iron levels, which were worse for RNYers: http://www.springerlink.com/content/p73087r79056k454/ . Part of the reason why so many people think that the DS results in dangerously low nutrient levels is because the DS is often confused with some of the older procedures from which it developed. Improvements that led to what the DS is today have vastly reduced problems of this nature. Even many well-meaning doctors who specialize in the RNY instead of the DS don’t really “get” that the DS is different from the old JIB and other malabsorptive procedures that aren’t performed any longer. Unfortunately, uninformed people are continuing to perpetuate some of the misunderstandings about the DS being “dangerous” or too drastic. Just like the RNY, the DS will require regular supplements to be taken every day for the rest of your life.
Other myths about the DS include:
· It’s only for super morbidly obese people.
Fact: when the DS was new, it was often reserved for the people with the highest BMIs. But that was then. It has now been shown to be an excellent option for morbidly obese patients of BMI with the same criteria used to get an RNY. It hasn’t been shown to cause people of lower BMIs to drop to dangerously low weights. Even patients who had a DS with a starting BMI of 35 have stopped losing at a normal weight and have done wonderfully with the DS. Many people (and even some surgeons who aren’t thoroughly educated on the DS) still mistakenly think it’s just for the highest BMIs.
Several articles have recently been published about how much better the DS results are for the super morbidly obese compared to other procedures. This may explain why some people believe that the DS is only for the super morbidly obese. These articles were merely pointing out that the DS should definitely be the “operation of choice” for the super morbidly obese, but they weren’t meant to discount the fact that it also has the best results for morbidly obese as well.
· It has a higher death rate.
Fact: Studies have shown that the mortality rate is not different enough from the RNY to be statistically significant (http://www.ncbi.nlm.nih.gov/pubmed/18219767?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum ). Of course, selecting an experienced surgeon is always extremely important.
· It can’t be reversed.
Fact: While it’s true that the stomach, after being trimmed down, can’t be enlarged again (it does stretch to a much larger size on its own anyway); the intestines can be reversed to their normal pre-malabsorptive arrangement. Also, while it’s very rarely required, it’s possible to lengthen or shorten the intestinal channel to slow down or boost weight loss or to increase absorption if necessary.
· Insurance doesn’t cover it.
Fact: The government insurer Medicare covers the DS under the exact same criteria as the RNY.
