[xsmith95]

It is said after surgery we become malabsorpsive, right... So here is my stupid question... If we are malabsorpsive, how many calories do we really absorb? How many carbs?

I had asked my surgeon this and he could not answer my question, he said he had never thought of that and had never been asked that question. So does anyone here know?

Shelley

[fr1endly2]

shelley honestly i dont think doctors have the real answer on that.
EVERY person is different. I think our digestive systems work differently
and food passes thru at different rates.
MAYBe someone out there knows more i didnt.
HOPE your day got better !
MISS you!
SHOULD be online more the rest of the week
HUGS n KISSES

[DocSanae]

Hey Shelly, great Q!
You had me digging up some books and checking stuff out.
To put in a nutshell, no, you do not really end up with malabsorbtion.
The capacity of the intestines to absorb is much much greater than what we actually need, the total area being the size of two tennis courts
With the bypass, true you have lost 1/4 to 1/3 of that, but the body eventually adjusts, and starts absorbing just about everything once again with a few exceptions.

The most serious of these is VB12 because the intrinsic factor that activates B12 which in turn helps in the absorbtion of iron, is produced in the bypasses portion of the stomach, which is why it becomes an issue.
Malabsorbtion of lipids, including fat-solubule vitamins may occur on occasions, but carb and protein malabsorbtions are very rare, unless you have some type of disease that degenrates the surface of the intestines, or causes lack of certain enzymes necessary in absorbing.

Immediately after bypass surgery, you lose weight because of the drastically decreased intake of food due to the small pouch, and malabsorbtion because your body has not yet adjusted to the shortened route of your intestines, but eventually, the absorbtive capacity of the intestines return to normal.

So, by the time you get into maintenance weight, you need to have changed your eating habits to a healthier level, both in types of food you choose, and the portions you eat, and stick to it; also adapt a healthy life style that includes plenty of exercise. Keep in mind, there are those who regain once they slacken their control. That one can regain weight is proof that malabsorbtion from the bypass surgery does not last forever. Once the body function kicks back to normal, it's the new habits that you've formed around food and exercise that keeps your weight at goal.

[xsmith95]

Now with all that, you make ask another question... How long do we have before our bodies go back to the absorbsion stage? Is it 12 - 18 months or is it sooner? I know you say by the time we get to maintenance weight, but for those of us that are loosing slower, could this play a part in that?

Shelley

P.S. Thanks for the hard work you are doing for us. I am glad that I can finally get some answer that is understandable.

[DocSanae]

I haven't yet found any medical statement on this, but probably a year or two at most--your "honeymoon".

For those who are losing slower, it could be that their absorbtion is better, but I think the choices with food and exercise would be more of a factor. Also, the timing of when you eat, when you exercise in relation to your activities during the day. For instance, with the same amount of food, if you eat it in the morning, or just before going to bed, will make a big difference. If you eat something right before you go to sleep, it's going to end up in storage, instead of being your fuel for the day, as something eaten in the morning becomes. Besides, some people do have a more sluggish metabolism than others.

The most important factor is, are you eating less than you need per day (which keeps you on the losing side) or are you eating more than you need per day (which will make you gain weight)? When you've achieved goal, you need make your intake equal to your expenditure. That is the final place you have to get to, when it comes to food and eating.

[DocSanae]

You will regain your weight if you let your eating go back to what it was pre-op. The pouch does not stay the size of a golf ball (which is how big it is, immediately post op) but it enlarges a little--I believe to about 4-6 oz size. If you eat say in one meal 2-3 Wendyburgers plus a plateful of fried potatoes, drink lots of soda pop, etc ...yes, your pouch will get much larger, and yes, your weight will come back.

That is why WLS is a tool, and only a tool. It is not the end to the means. It's a tool that gives you the chance to lose, and while you are losing, gives you the time to develop healthier eating habits, both in the choice of food you eat, and the portion that you eat.
It is a tool to enable you to learn how to control your eating.
It's a tool to teach you the feeling of "full" but unless you stop eating with that fullness, the pouch will eventually enlarge more than the 4-6 oz size considered desirable.

The surgery itself does not insure life long weight loss. The changes you make in your life style while the weight loss from the immediate effect of the surgery is going on, is what insures your good health and weight.

[fr1endly2]

thanks doc I love the information
you have shared!

YOUR the best
((HUG)))

[freebird]

great info Doc. I have heard of other people who have had the surgery and gained the weight back and then had the surgery all over again. to me this would not be desirable because why do it the first time if you are not going to stick to the maitanance after the weight loss.
So Doc, not that i'm encouraging this but is it possible, for whatever medical reason that might make this lifestyle with the new pouch dangerous to an individual, to have this surgery reversed? I mean if they can do the surgery on the same person more than once does it go the other way also? if it was medically necessary, i have only heard of one girl who couldn't stop losing weight and needed something done because she was dangerously underweight no matter what she couldn't go back up, they even hospitalized her to make sure she was eating enough, and she couldn't eat enough to gain weight. never hear how this problem was solved so i just thought i'd ask? thanks

[DocSanae]

Coupled with this thread, I hope, if you haven't already checked it out, will then check out this other thread, and go along to the article linked to it. I wrote the article to give you an idea of how much you can eat once you attain goal.
I hope the info put together will give you a better idea of what you must do post op in order to insure the success of your journey.

(((((((HUGS)))))))) to all!

[DocSanae]

freebird, I have heard of post-ops who go down the route of anorexia once they succeed with WLS. This has to do with what the true issue was, that made these people turn to food for comfort, or to starve themselves as punishment--I hope I don't sound judgemental or harsh, here, we all have to have a route of escape when we are pushed into a corner; but, some are stronger and don't get pushed easily, some are sensitive and get floored often, some will turn to a constructive form of activity to work off their anger and frustration, while others will turn to something that eventually works against themselves. What we (drs) try to do, is to help straighten out the route for the people who come to us for assistance, and having been in the postion of observing a lot of such people, I do see many hurting themselves without being conscious about what they are doing, and this makes me sad.
Ooops, kinda got OT.
Anyway, with lap-band, reversal is not so difficult, the band is taken out, and most times, that is it. With bypass, it will not be as easy. Both the stomach and the intestines will have to be reconstructed, and how sucessful that surgery is going to be, porbably depends on how long out one is-- the longer out, the more difficult the reconstruction will be. However, I am not a surgeon, so if you really want to know, it would be better to ask your surgeon about what is done in such cases.