WLS World: April 2008

Duodenal Switch

I would like to share my personal post-op experiences, fact based knowledge and background regarding my surgery which is a combination of the Vertical Sleeve Gastrectomy (VSG) and Duodenal Switch (DS), performed under 1 surgical procedure. It is medically known as a a gastric restriction with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy to limit absorption. It is known by its formality as a bilio-pancreatic diversion with duodenal switch and abbreviated as BPD/DS or DS. A not so wordy way to say it is sleeve gastrectomy with duodenal switch or just the DS.

I had my laparoscopic duodenal switch procedure on Nov 14th, 2006 for the surgical medical treatment of morbid obesity that can kill you. I am still the same person within, only my outer shell has morph to what I once looked like before this disease imprisoned me. The most important thing that matters is, I have my health back and that means more to me than the actual weight loss.

What is your body if you are not healthy with your respiratory, circulatory, cardiac and digestive system working properly and have mobility to be able to do things on your own, independently with no limitations, no complications or becoming a fatality?

This is what bariatric surgery outcome has done for me, give me my health as well as my life back!

The Duodenal Switch (DS)

The DS procedure has been performed since 1988 and combines restrictive and malabsorptive elements to help achieve and maintain long-term weight loss:

1. by restricting the amount of food that can be eaten through a reduction in stomach size

2. limit the amount of food that is absorbed into the body through a rerouting of the intestines

3. have a metabolic effect induced by manipulating intestinal hormones as a result of intestinal rerouting

The overall effect is that DS patients are able to engage in fairly normal, free eating, while having the benefit of taking on the metabolism of a lean individual.

Monday, April 14, 2008

17 months post-op

I am 17 months post-op. The month of April has been extremely busy with various agendas and projects going on. So far, everything is going well and life is back to where it was prior to the fiasco of becoming and being imprisoned by morbid obesity. I am wearing size 7/8 and think I like this weight and clothes size. I am bouncing between 145 and 150 lbs. I have gotten down as low as 143 lbs. I am not sure, I want to lose anymore weight. Overall, I feel comfortable where I am at and the weight looks good on me since I do have curves on my body.

Below is my current regime of vitamins and supplement. It varies as time goes by, being constantly readjusted as needed:

When I wake up:
1 Bariatic Advantage Iron Chewable (29mgs)

Breakfast time:
1 Centrum Performance multivitamin
2 Bariatric Advantage Calcium Citrate (800mgs)

After Breakfast Snack:
1 Bariatric Advantage High ADEK Multivitamin Chewable

Lunch:
1 Centrum Performance multivitamin
2 Bariatric Advantage Calicum Citrate Chewables (800mgs)

Dinner:
1 Centrum Performance multivitamin
2 Bariatric Advantage Calcium Citrate Chewables (800mg)

After Dinner Snack:
1 Bariatric Advantage High ADEK Mulitivitamin Chewable

Before Bedtime:
1 Bariatric Advantage Iron Chewable (29mgs)

2x a week:
Solaray Dry Vitamin E (400 IU per serving)
Jarrow Formulas Biotin 5mg

1x a week:
Drisdol, Calciferol Vitamin D2 (50,000 IU)

The following regime is working very well for my current situation. My blood work has not shown any deficiencies and my body is not showing any signs or symptoms of deficiencies either. If there are any signs, symptoms or results of deficiencies, it will be reevaluated and adjusted accordingly.

I get many private messages about this, is what do i eat mainly on a daily basis. Instead of answering each person, let me just post it here on my blog.

Top 5 breakfast I eat:

1. 4oz grilled salmon, seasoned with Goya adobo, cooked in alittle olive oil and butter (35gms protein)

2. western omelet with milk, onions, red & green peppers, ham, mushrooms, american or cheddar cheese (21gms protein)

3. 1 cup Special K with red berries cereal with 4 oz Lactaid fat free milk with 3 tbsp Champion Nutrition 100% Pure Whey Protein Stack vanilla flavor (20gms protein)

4. grilled cheese with ham and tomatoes or bacon and tomatoes (16-21gms protein)

5. Optimum Nutrition 100% Whey Gold Standard Rocky Road protein with 12oz milk (36gms protein)

Top 5 lunches:

1. grilled salmon

2. Chef Boyardee spaghetti and meatballs

3. chili made with Goya chorizo, Nathan's hot dog, black bean, Bush baked beans, canned tomatoes, ground beef with cheddar cheese, sour cream and cilantro

4. chicken breast (grilled, fried, stuffed or saute)

5. tuna sandwich made with mayo, Miracle Whip, onions, scallion, pickles, lemon, mustard on white bread

Top 5 dinners:

1. filet mignon or ribeye steak, coleslaw, with either baked potato, butter and sour cream or white rice with cuban style black beans, grilled or steamed vegetables (zucchini, squash, pumpkin, sweet white potatoes, yams, onion and/or portabello mushrooms), canned mexicorn

2. salisbury steak, mashed or baked potato, butter and sour cream or potato salad or macaroni salad, coleslaw, canned mexicorn

3. crabcakes, rice pilaf with shrimp and spinach, coleslaw

4. chicken either grilled, stuffed, stewed, fried with baked potato, sour cream and butter or Stovetop stuffing or steamed, grilled or saute vegetable medley, macaroni salad or coleslaw

5. meat, spinach or eggplant lasagna or stuffed shells made with spinach, ground beef, ricotta and mozarrella cheese

Top 10 food I occasionally eat (no particular order):

1. Jamaican beef patty with melted cheddar or mozzarella cheese

2. monfongo with pork crackling, lots of garlic and mojo sauce

3. roast beef sandwich with mayo, salt and pepper on white bread

4. corned beef hash made with tomato sauce and onions, white rice and canned mexicorn

5. beef negamaki with a house salad with avocado, crab legs and Japanese ginger dressing, miso soup

6. Nathan's hot dog with cheddar cheese, grain mustard, onion sauce, sauerkraft on warmed bun

7. cheeseburger with bacon and mushroom, 2 White Castle cheeseburgers or 1 small Burger King Whopper Jr. with cheese

8. Homemade broiled tilapia parmesan, crabmeat stuffed mushroom, coconut shrimps with pina colada sauce or grilled, fried, saute, breaded shrimps, lobster, crab, fish

9. gyro with onion, tomatoes, lots of tsatziki on pita bread

10. breaded mozzarella sticks with marinara sauce, chicken parmesan with mozarrella and marinara sauce or those Tyson bbq chicken tenders

Top 5 daily drinks:

1. Lactaid fat free milk (I don't like the taste of skim, lowfat or whole milk)

2. Tropicana Light & Healthy orange juice

3. Tang orange drink

4. Kool Aid tropical punch with splenda

5. Nestle water

I do drink sweetened ice tea (but have limited it, to only when I go out to eat)

Current food intolerance:

1.Anything made with asparatame, acesulfame-k or saccharine such as Nutrasweet, Sweet & Low, Equal, Spoonful, Sunette or Sweet One

2. Anything with certain amount of sugar alcohol in it

3. Any carbonated drink or soda (including diet) and even if left to be flat

4. Any diet drink such as Crystal Light, diet ice tea, etc

5. ??? (I have no other food intolerance that I am aware of)

5 leisure snacks I will indulge in, every once and awhile:

1. Smart Food white cheddar popcorm

2. Entenmann's chocolate chips cookies

3. Haagen Dazs strawberry cheesecake ice cream

4. homemade cream cheese sugar cookies made with Splenda

5. brownies, pumpkin pie with graham crust or pecan pie

I can only eat:

1. 1/2 NY style thin pizza with heavy toppings

2. 3 to 4oz of beef or poultry

3. 1/2 to 3/4 cup of rice any style

4. 1/2 small or 1/4 medium potato with sour cream and butter or cheese, chives and bacon bits or cheddar cheese, chili and cilantro

5. 1/2-3/4 c pasta with meat marinara or seafood(able to digest fresh pasta better than dry pasta)

Basically, at 17 months post-op, I do not eat much in portion. Another thing that people inquire about is gas and bowel movements. With the DS, all is controllable and a person knows what will trigger then to have food that will make them gassy. There are some DS post-op who eat high calorie and high fat food. That is an option if you want to eat such and not mandatory. My average calorie intake is about 1200 and I am not much into eating fatty food. But, the option is there if I want it. With the DS, calories and fat is not of concern since most is not absorbed. That is why most DSers do not gain weight, worry or focus on counting calories or how much fat they are eating. With the DS, you also malabsorb complex carbs, as high as 50%. But, it depends on the DSer internal length of various limb and common channel. I know I do not malabsorb 50%. I malabsorb about 30-40% of the complex carbs. We have to take focus on simple carbs which is sugar since it is what will cause a DSer to gain weight.

Protein is very important and it is what is focused first when eating. After that, is carbs. I also focus on vitamins that I can get from food. One other important daily thing is fluids. I try to aim for more than 64oz, but I don't always meet that amount. I am still struggling with no desire to eat and when I do eat, it is very small amount usually 5 teaspoon max or 1/4 to 1/2 cup worth of food per meal serving. Due to that, I rely heavily on my protein supplements and mixing it always with milk to get alittle more protein out of it. 1oz of milk is equal to 1 gm protein. I do drink a lot of milk and it is my preference of choice to drink. But, only Lactaid fat free milk.

I like to eat these whenever the mood fits:

1. Lay's or Wise potato chips plain, bbq or sour cream and chives or onions flavors

2. Dorito's corn chips with sour cream

3. soft ice cream with melted marshmallow

4. cheesecake, cinnamon raisin, pecan or cheese danish or buns, corn bread, blueberry muffins, banana nut bread

5. General Tso chicken or Kung Po chicken or shrmps

On a daily basis:

I will drink multiple times, Optimum Nutrition Gold Standard Rocky Road Protein with 8, 10 or 12oz of milk that ranges from 32 to 36 grams of protein. I usually drink this as my snack. This will also provide me with meeting my protein quota for the day, since there are many times and days that I have no desire to eat or even feel hungry to need to eat.

As I have written before, with the DS you malasbsorb 80% of the fat you eat and malabsorb a ballpark between 30-60% of the calories and 20-50% of the complex carbs. With any WLS, the DS also does not malabsorb any simple carbs, BUT do malabsorb complex carbs. Therefore, calories and fat are not focused much upon, only carbs and the most important thing protein. With the DS, you can malabsorb from 25-40% of the protein. The calories, carbs and protein malasorption varies from DS post-op to post-op according to length of their common channel, small bowel, alimentary and biliopancreatic limbs. The only way to actually determine how much a DSer malabsorbs is through a control study in which the same amount of calories, carbs, protein and fat is given during a set period of time, then it is calculated through their waste (excrement) to determine how much is being absorbed and malabsorbed through their system. The only fact that is known is a DSer is able to malabsorb 80% of the fats and 0% of the simple carbs (sugar).

Sunday, April 13, 2008

people interested and inquisitive about the DS

I get lots of private messages on this OH site with people interested and inquisitive about the DS. Not only pre-ops, but a lot of post-ops of other surgery types. They are amazed with my food choices and what I am able to eat and not get sick, negative side effects or gain weight.

They also ask me about the vitamins I have to take and if I am required to take 50,000 IU of vitamin D3 daily as the other DSers do. I tell them honestly, that even with the RnY, you still have to take certain and various vitamins for life. I usually tell them it is not the quantity, but the type you need to take and it is adjusted accordingly with each blood result as needed. I also inform them that each DSer take different type of vitamins and nutrients since we are all not alike. But, there is 2 basic vitamins and supplements that is a must and minimum requirement to survive and be healthy as a DSer, which are multivitamins and calcium citrate. As long as those 2 are the core to the daily regime, anything else taken is based according to each's health and blood test. The requirement needed may change with time or if there are any deficiencies or high value that may be considered excessive or out of range.

One thing, that must be taken into consideration is the use of taking megadoses of certain vitamins and/or nutritients that may cause toxicity, adverse reaction and allergies to either food or your surroundings. The megadoses usage also includes post-ops with malabsorption issues. Some DSers take 50,000 IU of vitamin D3 every single day. That is an option and not required or considered mandatory. I do not need to take such amount daily. Taking 50,000 IU once a week or 2-3 times a week is suffice and safe for the body. Taking it every single day and for a long time is questionable and if longterm use causes any effects to the health that may not be positive. It should be done with observation to monitor diligently, take awareness at the amount and length of time and have knowledge that such extremely high and excessive amount taken every single day for a long period of time may affect your health in a negative manner.

I take Drisdol which is vitamin D2 calciferol. Vitamin D3 is Cholecalciferol. Although, it is D2 ergocalicerol, its main purpose is for my body to absorb the calcium from the stomach and to help with the functioning of calcium in the body. It is what is meant for my condition and what is being monitored. Ergocalciferol is for treatment of vitamin D deficiency osteomalacia, hypoparathyroidism and hypophosphatemia, which is an electrolyte imbalance.

There are those who take D3 at 50,000 IU daily. That is fine for them as long as they know how to monitor the amount they are consuming safely, that is suitable for their needs and how it improves their health. It all comes down to your current medical health, what your blood results are saying, what disorders or deficencies you have and what are the proper treatment of medication and nutrients for your body as well as health needs. Vitamins and nutritients are revised as needed per person and according to deficiency or current values of interest.

For those who want to take solely to whoever is on the net giving advise regarding vitamins, etc, should know, it is NOT on a professional level to dispense, but personal views and opinions, To each their own. I prefer to work with my medical staff who are medically trained and licensed in medicine and health care. I will not place my life or health to rely on a person I don't know of their background, if they have licensure in healthcare or nutritional education from any salesperson with a pitch because they say so and so works for them or others. The job of a salesperson is to make that sell using whatever tactic they can to convince you and make that profit. It may work for some, but with other factors in our health should be considered and what is the longterm effects taking such, I work with what is needed for my current health and adjust as needed. If I need to take D3, it will show in my blood results and will work with adding it, if needed to improve my health.

People can take megadoses of 50,000 IU vitamin D3 daily for a short set time. But, NOT for a prolong period or even permanently as for the rest of your life on a daily basis. You have to be realistic and truely understand what you are doing and how it actually works and affects you when taking it longterm. Your body is not meant to take megadoses every single day for months or even years. Just like medications, vitamins and nutrients have to be adjusted with time. People have to ask questions to the medical professionals, physicians, research it online or even verify the source indepth that taking extreme amount known as megadoses of D3 at 50,000 IU daily for a prolong amount of time might cause vitamin D toxicity. You are able to take vitamin D in high doses, for a temporary amount of time and be safe and healthy for you, but not for too long amount of time. Take it for certain amount of weeks will not cause harm to your health. Taking it for a prolong period or even permanently will cause toxicity from calcium formation that will harm your organs, such as your kidneys, heart and lungs. This is permanent damage to your organs.

Buyer beware and do your background inestigation, research and homework. Don't rely, depend or take a person's recommendation to sell you stuff as being the sure thing at face value. Salesperson's job is to convince you to buy their product and on a regular basis as you become a recurring client to their sales. Taking megadoses of vitamin D3 for short period is OK. But for prolong period or to take it permanently, you have to be aware of its consequences to your health. Below is my current regime of vitamins and supplement. It varies as time goes by, being constantly readjusted:

When I wake up:
1 Bariatic Advantage Iron Chewable (29mgs)

Breakfast time:
1 Centrum Performance multivitamin
2 Bariatric Advantage Calcium Citrate (800mgs)

After Breakfast Snack:
1 Bariatric Advantage High ADEK Multivitamin Chewable

Lunch:
1 Centrum Performance multivitamin
2 Bariatric Advantage Calicum Citrate Chewables (800mgs)

Dinner:
1 Centrum Performance multivitamin
2 Bariatric Advantage Calcium Citrate Chewables (800mg)

After Dinner Snack:
1 Bariatric Advantage High ADEK Mulitivitamin Chewable

Before Bedtime:
1 Bariatric Advantage Iron Chewable (29mgs)

2x a week:
Solaray Dry Vitamin E (400 IU per serving)
Jarrow Formulas Biotin 5mg

1x a week:
Drisdol, Calciferol Vitamin D2 (50,000 IU)

The following regime is working very well for my current situation. My blood work has not shown any deficiencies and my body is not showing any signs or symptoms of deficiencies either. If there are any signs, symptoms or results of deficiencies, it will be reevaluated and adjusted accordingly.

Tuesday, April 8, 2008

Readjusting my vitamins

I will readjust my vitamins and supplements this weekend and remove the extra BA vitamins chewables during snack time and take the magnesium oxide with my vitamins and calcium citrate during my meals. I do not need to take the extra 2 multivitamins (it was an option), since I am using Centrum Performance now. Therefore, no more supplements during my snack times, since I am readjusting it and moving what is needed. In the morning iron, during breakfast the Centrum, calcium citrate chewables and magnesium oxide, lunch the same , dinner - ditto and bedtime iron. These are my essentials now:

daily regime
1 iron chewables 2x daily (total 58mg)
1 Centrum Performance 3x daily
2 calcium citrate chewables 3x daily (total 2400mg)
1 magnesium oxide 2x daily (total 800mg)

Morning when I wake up:
1 Bariatric Aadvantage iron chewable (29mg)

Breakfast:
1 Centrum Performance
2 Bariatric Advantage Calcium Citrate chewable (total 800mg)
1 Magnesium Oxide 400mg

Lunch:
1 Centrum Performance
2 Bariatric Advantage Calcium Citrate chewable (total 800mg)

Dinner:
1 Centrum Performance
2 Bariatric Advantage Calcium Citrate chewbles (total 800mg)
1 Magnesium Oxide 400mg

Bedtime:
1 Bariatric Advantage iron chewable 29mg

every other day to 3x a week
serving taken separately throughout the day
1 dry vitamin D3 10,000 IU (2x for the day, total 20,000 IU)

I am planning on having more home cooked meals done. At least, I know what ingredients go into the preparation, instead buying the ready made ones or going to the restaurants and trying to decipher each ingredient or how fresh it is. I am beginning to enjoy making restaurant type of food at home and it keeps me busy as a hobby. I feel like a gourmet chef and have fun entertaining with it once set at the table. I do make enough food to last for a few days and give me a break cooking every day.

What is the surgery I had all about?

The Duodenal Switch, although a bariatric surgical procedure for weight loss, is NOT a gastric bypass.

This type of method keeps a portion of the duodenum in the food stream. The preservation of the pylorus means that food is digested normally in the stomach before being excreted into the small intestine. The outer curvature of the stomach pouch is removed known as partial gastrectomy that restricts food to be consumed as well as limit the amount of food intake, especially fat to be absorbed into the body which is caused by the intestinal switch. This effectively restricts its capacity while maintaining its normal functionality. The BPD-DS procedure keeps the pyloric valve intact in which helps eliminate the possiblity of dumping syndrome, ulcers as well as stoma closures and blockage known as strictures. The intestinal tract is divided into 2 limb sections (the food limb and the biliopancreatic limb) that are reconnected and meet together to what is known as the common channel (the end limb portion of the small intestinal tract) and moves on to the large intestine. The food limb is also known as the alimentary limb, where the food is digested. The biliopancreatic limb basically processes the digestive juices. When both meet at the common channel at the bottom of the small intestines, the food and digestive juices mixes together and moves further on to the rest of the digestive tract system.

In plain English, with the BPD-DS, you have 2 intestinal tracts, one tract is to digest the food and the other tract is to digest the gastric juices in which both tracts known as limbs meet together again at the end of the small intestines. This is what a Duodenal Switch function is primarily about and explained in the simplest and generic form without getting in depth, if the above synopsis is too technical to comprehend.

The advantages of having the Duodenal Switch procedure are:

You have a more normal stomach that allows for better eating quality

You can drink with meals

There are no dumping syndrome since the pylorus is not removed

There is a minimal risk of having ulcers

There are no strictures that will occur

The intestinal bypass is partially reversible for those having malabsorptive complications

Carbs can be well absorbed, yet must be careful

The disadvantages of having the Duodenal Switch procedure are:

There is a chance of chronic diarrhea and possibly smelling stools and gas. This can be contributed to your dietary intake and can be controlled to avoid occurring

Malabsorption can lead to anemia, protein deficiency and metabolic bone disease in up to 5% of patients

You must keep a regime for daily intake of vitamins supplements for life, especially calcium, vitamin A, D, E and K

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What is the Duodenal Switch?

With the DS procedure:

The stomach, although reduced to 50-75% its original size is fully functional. The duodenum is also fully functional with no bypass mechanism occurring. The entry and exit port of the stomach and the pyloric valve are untouched in its digestive configuration and left originally the same way before and after surgery. Keeping food in the stomach until it is digested prevents dumping, provide satiety and absorption of vitamins and minerals into the body.

This is important, since, the duodenum is the part of the intestine where protein, calcium, iron and vitamin B12 are absorbed and with the Gastric Bypass causes these four nutrients to not be absorb. The DS stomach processes the intrinsic factor that contains polysaccharide and protein components to make cyanocabalamin to be absorb as vitamin B12. The stomach and duodenum organs missing from the digestive system of the Gastric Bypass and is the main reason for pernicious anemia that is an iron deficiency developed due to lack of vitamin B12.

Even though, the DS has a greater malabsorptive factor, it actually has more normal nutritional absorption than the Gastric Bypass because the duodenum, stomach and pylorus are still involved in the digestive process. Therefore, the Gastric Bypass has MORE MALABSORPTION of vitamins and mineral causing greater possibilities of deficiencies, due to the complete removal (bypass) of the stomach and duodenal from its digestive absorption process and to have no function whatsoever.

Restriction
The restrictive part of the DS procedure is known as the vertical sleeve gastrectomy (VSG) and is achieved via partial gastrectomy (removal of the outer/greater curvature of the stomach). It reduces the size of the stomach 25-30% its original size and into a 2-3cm in diameter tubular structure which holds 3-4 ounces (80-120ml), compared to teh Gastric Bypass that holds 15-30ml restriction of food.

The grehlin hormone is also removed and eliminates head hunger, cravings and binging from occurring. The sleeve gastrectomy keeps and maintain the pylorus valve intact for the function in the emptying of the stomach contents to the duodenum at its normal controlled pace for better food tolerance and to limit the amount of food to be eaten.

Malabsorption
The malabsorptive component of the DS procedure is the intestinal bypass known as the duodenal switch. It is achieved by rerouting the small intestine into 2 intestinal tracts known as limbs. One tract separates the flow of food, known as the alimentary limb (or food limb) that measures on average 150-200cm, from the second tract known as the biliopancreatic limb (or digestive limb), where the flow of bile and pancreatic juices comes from the liver and pancreas to process for digestion. Reducing the amount of bile and pancreatic juices the food comes in contact with, reduces the amount of food that is digested and decreases absorption. The digestive limb, eventhough it is an intestinal bypass, is fully functional for processing in the digestive system.

Metabolic Effect

The alimentary limb:

1. absorbs proteins from ingested food

2. secretes the peptide hormone Enteroglucagon or GLP-1, which has 37 amino acids that controls the metabolism of glucose from undigested food. (This is the key reason (along with #4), why a DSer will NOT have Reactive Hypoclycemia occur or Diabetes resurface, even if they gain weight or are years out as post-op).

3. it suppresses the insulin response when carbs is ingested to reduce the amount that is converted to and stored as fat.

4. it increases insulin secretion as it decreases glucagon secretion from the pancreas that helps to treat and cure at a rate of 98.9% with PERMANENT REMISSION for Diabetes, even if there is a regain in weight.

Diabetes (type 2) will not return as per medical research and long-term studies that has been published, documented and recorded in medical journals, with the extremely small and rare exception of 1.1% whose Diabetes was still evident after surgery. With the Gastric Bypass, there is a high possibility that weight gain will cause Diabetes to resurface. It is NLIKELY with the DS to have post-ops with Diabetes or to have Reactive Hypoglycemia, as proven to occur among those with the Roux-en-Y or Gastric Bypass surgical procedure (whether at goal or regained weight), after being post-op for over a year or more.

For a RNY post-op, reactive hypoglycemia disorder does occur in those who never had Diabetes (related or non-related) prior to surgery or in their life. Again, this is NOT an occurrence that will happen with post-ops DSers.

Further down the digestive tract, the two separated limbs of the small intestines are rejoined to be connected at the ileum known as the common channel. This is where the food and digestive juices begin to mix and limit fat absorption, essential for good health to occur. The common channel length varies according to Hess method (100cm) or according to patient's needs, malabsorption level desired, etc., from 50-150cm. The common channel section is the ONLY portion of the intestines that a DSer is able to absorb calories, fats and complex carbohydrates and no where else in the small intestine digestive system.

With the DS, a person eating food will be unable to absorb:
* 50% of calories
* 80% of fats
* 40% of complex carbohydrates
* 0% of simple carbohydrates

Unlike the Gatric Bypass, the Duodenal Switch is an intestinal bypass and NOT a gastric bypass procedure. It is also a gastric restrictive procedure and again NOT considered a gastric bypass, since, digestion begins in the stomach breaking down food and it keeps the pyloric muscle between stomach and small intestine intact, allowing the stomach contents to start their digestive process before food enters the duodenum. This preservation eliminates the symptoms of dumping syndrome, marginal ulcers, strictures and blockages.

The gift of the DS is about OPTIONS. If I do eat anything, the malabsorption level and metabolic effect will prevent me from gaining weight and won't affect my arteries, blood or cholesterol level.

The majority of DSer do not have bathroom (diarrhea) or gas (flatuence) issues. A DSer become very much in tune. listening to their body for signals and its digestive system. You might have to moderate some food, but it does not need to be omitted or considered forbidden. The focus is not on calories, fat and not even on complex carbs as much. The main focus is on protein and nutrients. We must all eat food to survive and fuel our bodies for energy and nourishment.

The malabsorption of the DS is very powerful and will help you lose weight and keep it off long term. Without it, you're just on a diet after diet whether low calorie, low fat, avoiding certain food to not gain weight for life. The DS malabsorption eliminates the need to count fat, calories, certain amount of complex carb or any other diet mentality practices needed to either lose weight or to not regain weight. You eat normally (just smaller portion than a non-WLS) and do not have to deal with issues that it will harm or "punish" you since your stomach is fully functional to properly digest the food.

Gastric Bypass versus Duodenal Switch

In RNY procedure:
The duodenum and pyloric valve are bypassed and the intestines are connected to a newly created stomach pouch, known as a stoma. This digestive configuration is known as a gastric bypass. The stoma is able to hold one ounce of food, but its exit port is always open and does not store food causing it to glide through into the intestines non-stop which causes a possibility of dumping syndrome. Food is held in the pouch, depending on certain texture or bulk may get stuck with difficulties in processing to pass through the stoma, if not chew down to mush consistency. The stoma is similar to a funnel and does not have the ability to process food. Some consider dumping to be a key component of gastric bypass. Yet, it has been medically proven with published scientific report, medical data and research studies that there is no relation between dumping and weight loss. Due to the absence of a functional stomach and duodenum, nutrients are unable to be absorb. The duodenum is the site where most of the breakdown of food passes through and secrete an alkaline mucus that supports the intestinal enzymes and aids in the absorption of nutrients. The stomach is a secretory organ that include digestive enzymes, hormones, hydrochloric acid and intrinsic factor for vitamin B12 absorption are missing with the RNY or gastric bypass.

With the DS procedure:
The stomach, although reduced to 50-75% its original size is fully functional. The duodenum is also fully functional with no bypass mechanism occurring. The entry and exit port of the stomach and the pyloric valve are untouched in its digestive configuration and left originally the same way before and after surgery. This allows food and drink to be consumed at the same time and become iso-osmolar during digestion.

Keeping food in the stomach until it is digested prevents dumping, provide satiety and absorption of vitamins and minerals into the body. This also helps control weight as the DS stomach stretches a bit with time, as it is normally suppose to do. The pylorus stays shut while food and fluid are in the stomach, causing the stomach to work as a hopper and digest the food that provides nutrients as it process, then passes into the duodenum as it continues to absorb nutrients to the body.

This is important, since, the duodenum is the part of the intestine where protein, calcium, iron and vitamin B12 are absorbed and with the RNY causes these four nutrients to not be absorb. The stomach processes the intrinsic factor that contains polysaccharide and protein components to make cyanocabalamin to be absorb as vitamin B12. The stomach and duodenum organs missing from the digestive system of the RnY or gastric bypass is the main reason for vitamin B12 deficiency to occur.

Even though, the DS has a greater malabsorptive factor, it actually has more normal nutritional absorption than the RNY because the duodenum, stomach and pylorus are still involved in the digestive process.

As can be observed in the chart above, the DS is able to provide LESS MALABSORPTION of nutrients compared to the RNY, since a portion of the the true stomach and the duodenum are left intact and in full functional capacity to process in its digestive system.

Therefore, the RNY has MORE MALABSORPTION of vitamins and mineral causing greater possibilities of deficiencies, due to the complete removal (bypass) of the stomach and duodenal from its digestive absorption process and to have no function whatsoever.

The duodenal switch surgical portion has been perform as a stand alone treatment for Diabetes on obese and non-obese patients for over 20 years, based on the mechanics and metabolic process that takes place in the digestive system.

The majority of DSer do not have bathroom (diarrhea) or gas (flatuence) issues. A DSer become very much in tune listening to their body for signals and its digestive system. It all comes down to, the DS does most of the work for me, not me do most of the work to stay healthy or lose/maintain my weight. It is pleasant life to live with no restriction of food or ingredient being denied, considered wrong, not allowed or taboo. You might have to moderate some food, but it does not need to be omitted or considered forbidden.

The focus is not on calories, fat and not even on complex carbs as much. The main focus is on protein and nutrients. We must all eat food to survive and fuel our bodies for energy and nourishment.

The malabsorption of the DS is very powerful and will help you lose weight and keep it off long term. Without it, you're just on a diet after diet whether low calorie, low fat, avoiding certain food to not gain weight for life. The DS malabsorption eliminates the need to count fat, calories, certain amount of complex carb or any other diet mentality practices needed to either lose weight or to not regain weight. You eat normally (just smaller portion than a non-WLS) and do not have to deal with issues that it will harm or "punish" you since your stomach is fully functional to properly digest the food.

Metabolism
The actual duodenal switch in your intestines kick start your metabolism, even after being 5 years post-op. It truly is not easy to regain weight (unless you have mental issues with being non-compliant. Although, living with the DS is a very liberal and lenient lifestyle with hardly any restrictions or complicated regime). Simply stated, with the DS, you have options and it is up to you to what you want to eat if you want without harming your body through averse therapy or dealing with various dieting to lose or maintain weight. There is no drama eating food with the DS.

DS Lifestyle
DSer do not eat a lot of food per se. They may eat more frequently, but it is all basically portioned food every so often as needed. The VSG restricts the amount of food that you have in one sitting. DSers do not require to mandatory eat high fat food. It is an option, if you want. If a DSer is constipated, having the option to eat higher fat contents or even higher carb amount than usual, may help move things along. DSer do not have a lot of or more than normal, frequent daily bowel movement. On average, it is once to three times a day and all depends on what you eat. If you eat higher fat, there might be a possibility, you may go more. DSers do not pass gas all day. It all depends on what you eat.

Usually higher carbs or certain ingredients MAY cause gas to some (not the majority). Bowel and gas issues are the same as with all other WLS post-op individuals and not considered more or extreme. It is a fallacy. DSer are very much in tune to listen to their body and to its digestive system. Simple carbs, you have to moderate, as with all other WLS. Only thing is, you have the freedom to have it if you want, but know your limits.

Complex carbs are malabsorb, so enjoy that potato, corn, beans or favorite cereal. DSers on average malabsorb 40% of the complex carbs. One of the beauty of living the DS lifestyle is you are not freaking out, feeling guilty, having drama or need to count calories or fat from food because it will NOT cause weight gain as compare to other WLS.

You want fritters, that delicious savory sauce or gravy, that juicy marbled fat from a steak with all the au jus streaming down the side, the skin from a fried chicken, have creamy or flavorful oil based salad dressing or smear butter or mayo to your heart content to make whatever you are using it with taste good? Go ahead, it will not cause you to gain weight. If you want a fast food burger or fried chicken from KFC, no regrets. Both are high in protein, regardless of the amount of calories or fat it has because the DS is very forgiving to NOT allow your system absorb 80% of the fat, 50% of the calories and 40% of the complex carbs you eat.

It is all about protein and you more or less disregard the rest. You are also able to eat rice, bread, potatoes, raw vegetables, and because it is complex carb, do malabsorb some of the carbs from it. So, there is peace and no issues with food and most importantly, you want to drink that beverage, whether it is juice or carbonated with your food or meal, go ahead, it's all good (just make it low sugar, sugar free, best if it is caffeine free, too). If you are hungry, go eat and enjoy it. Your grehlin is removed, so you won't feel hungry all the times or have head hunger. If you are hungry, it means you are really hungry, so go eat. Food is no longer an issue because you will have the metabolism of a lean person. You eat because your body is signaling that you are truly hungry. You do not need to a plan a menu according to calories or fat (for yourself) because there is no cut off limit amount per day. Again, you won't be able to eat alot per serving. Food just doesn't become important that you think about it. You only think about protein. But remember, compare to calories, fat, complex carbs and simple carbs. You deal with one of them and that is knowing your limit or moderation to simple carbs. You can have it, including sugary stuff, just don't go buck wild exaggerating the intake amount every day.

Research, if you see any DSers having serious issues that they need to have a revision or having complications that it needs to be revised and especially to another surgery. The DS is very effective and rarely is there any failure due to its intestinal configuration to cause weight gain beyond your control.

Difference with RnY

RnYer have a 50/50 chance of having dumping syndrome and hope to have it to control their eating habits, needing that negative reinforcement for poor eating habits or "forced" to eat healthier or better quality of food. But it does not happen to all and 60% of the RNYers are left with the burden to be stuck on a low calorie, low fat, low carb diet for life on their own mental reinforcement because they did not get the gift of dumping syndrome to enable them to eat healthier with the contribution of their "tool".

This is why ther are some RnY post-ops who repeatedly, go over and over again to try to "recondition" themselves using the 5DPT (5 day pouch test) or the 3DLPT (3 day liquid protein test) as a sort of solution to help them out. But these options are not a weight loss regime or that they will lose weight on it if followed.

With the RNY, there are some side effects that can stop you from continuing on with your day and may even affect your health.

1. One is dumping syndrome, in which there are times the only solution is to go rest and sleep it off to get over the episode.

2. Second is reactive hypoglycemia, that affects your blood level, even if you never had diabetes in your life. It is also due to chromium, niacin, vitamin C and vitamin E not able to regulate the glucose level in their system due to the gastric bypass procedure. Vanadium may be helpful to normalize the metabolism and under a medical doctor supervision.

3. Third is food getting stuck or causing a stoma blockage (such as eating a raw carrot and didn't chew it down well), since you do not have a functional stomach that will grind food for you anymore. Some post-op sort to using meat tenderizer with some water to soften the bulk of food that is stuck or blocking the stoma for breakdown and does not remedy the condition right away.

4. Fourth is strictures, which may be painful and requires a trip to the hospital to have yourself dilated.

5. Fifth is marginal ulcers and especially in the blind stomach that can't be scope for evaluation.

6. Sixth is RnY should never use NSAID because they do not have the digestive acids to help prevent irritation inside the stomach lining.

If a person has a family history of arthritis, lupus, migraines or ulcers, this can be an important factor to decide on having the DS due to the need of NSAID and this means daily and for life.

Unlike the Gastric Bypass, the Duodenal Switch is an intestinal bypass and NOT a gastric bypass procedure. It is also a gastric restrictive procedure and again NOT considered a gastric bypass, since, digestion begins in the stomach breaking down food and it keeps the pyloric muscle between stomach and small intestine intact, allowing the stomach contents to start their digestive process before food enters the duodenum. This preservation eliminates the symptoms of dumping syndrome, marginal ulcers, strictures and blockages.

WLS World