Long-term weight loss .vs. Channel length & stomach size tradeoffs

[Brandy]

The excellent sticky post “Realistic Goals and Personal Responsibility” by DianaCox got me wondering about the trade-offs made during the DS surgery. Diana says “Personally, I would never accept a common channel longer than 125 cm, but that is my OPINION, not fact. The smaller stomach (3 oz vs. 5 or more, but no smaller) I think is a good idea, depending on the person.” She goes on to say “I'm NOT OK with surgeons who do a cookie-cutter surgery without measuring the small intestine (which can vary from something like 7 feet to 23 feet in length) and doing a proportional DS, or who don't vary the procedure based on age, BMI, health issues, etc. -- it has to be personalized.”.

Dr. Ungson’s (who I see in less than a month!!! ) web site says “… not a single body is equal to another one, and every single patient should be approached as unique case, so custom intestinal lengths are set depending on the DS patient's total small intestine length and/or other patient's features.”



So what are the patient features that matter? What are the tradeoffs?



I assume the malabsorbtion is the dark side of a shorter channel, but, and I realize I really have no real idea, the malabsorbtion aspect seems to me almost like being slightly pregnant. Either you take your blood tests and tweak your vitamins or you don’t. It doesn’t really matter if you need two vitamin K pills or one. I’ve heard that some people have to get intravenous vitamins, but I don’t know how often. Is this so twitchy that they are worried about achieving a length where the body cannot be sustained? And couldn’t they just change the placement with another surgery?

On the other end, how would life be different for me with a larger or smaller sized stomach after a few years? I can see a big difference in the short run, but if discipline is all that really keeps my stomach from stretching, after a few years it will probably end up the same size no matter if it starts out as a 3 oz or 6 oz after the surgery. Am I wrong?

What kinds of information should I be thinking about to discuss this with the surgeon?

Thanks!

 

[Charris]

I don't know about all the technical jargan and the ends and outs of the DS TO ME im still a newbie at 9 month.. but using my common sense part is if you already have it in your mind No Matter what the size stomach u start with it will eventually gonna stretch back out THATS EXACTLY whats going to happen. I had ERNY IN 2000. I had a revision and my pouch never stretched more than 2 oz like was supposed to. So I'm just thinking be careful allowing those type of thoughts sabatog your acceptance of weight slowly creeping back at some point

 

[Parousia]

From what I have been able to glean from everything I've read, the stomach size is most important for the rapid weight loss part of the DS journey, while the length of the common channel plays the biggest role in keeping the weight off. It is a bit more complex than that, but I think that is accurate as far as it goes.

My surgeon does a fixed 50 cm common channel and removes 2/3 of the stomach (not sure what that equates to volume-wise). He did use a more flexible method previously, but this is what he seems to have settled on as the best way to go. I was a little concerned about the degree of malabsorption such a short CC would give me, but it doesn't seem to be causing any problems. My nutritional status is better than it has been in a long time! I gather my stomach is on the large size compared to many (most?) on here, but I'm really glad it isn't any smaller, because I had a lot of problems swallowing in my first 3 months post-surgery (but then I do have a personal and family history of oesophageal problems, which may have been aggravated by the surgery). I'm not losing particularly quickly, but that is probably my own fault. I'm not unhappy with my weight loss, tbh.

Anyway, this is just my own (limited) personal experience. I am a newbie, so take it for what it's worth .

 

[Parousia]

IDK @Parousia -- I think 70 lbs of loss in 5-ish months is losing just fine!

I'm not unhappy with my overall weight loss, but it has slowed right down. 2/3rds of it occurred within the first couple of months. I'm losing at a rate of between 1 and 2 lbs a week now, although some weeks I don't lose at all. From what I've heard and read, that is very slow so early out. I'd love to hear what your (and others) experience has been, though .

 

[Munchkin]

Just another example. My CC is supposedly 75cm, pretty short. And I never reached goal and I'm still fat. I will never see a normal BMI. I wish I was made of money so I could get the whole thing redone. I have serious doubts that my CC is really 75. I would bet it's much longer. Why? Because I am still fat and I have never had any vitamin/supplement deficiencies.

We are all different and it makes sense to me the surgery should be tailored to our individual needs. These are just my observations but I think women almost always need more oomph to their DS than most men. Also shorter women seem to need more help than tall ones. People with larger BMI's and more pounds to lose need more help too. If you can honestly say you can gain weight on 1000 cal per day you are probably a superabsorber. One of those people who would survive a famine. Superabsorbers need more help as well. And quite a few of the larger BMI folks are superabsorbers.

I think DSers as a whole would be more successful if their surgeons spent just a little more time figuring out their patient's real needs. Maybe some kind of a patient questionnaire to try to give some more insight to the doctor. It's easy to just assume I am fat because I eat too much but there are at least 2 sides to every story.

 

[Elizabeth N.]

There is so much more to it than "common channel length" and beginning stomach size. For example, how much total small intestine is bypassed for food? What's the total small bowel length? That has a huge impact on what the "common channel" really means in terms of percentages of small bowel length.

On me, my 75 cm common channel is about 11% of my total small intestine. On someone with a 400-cm small intestine, it's closer to 20%.

The degree of adaptation to the malabsorption is something that can't be predicted. If you go from absorbing, say 20% of fat calories to absorbing 40%, that's a big change in energy deficit.

These are just a couple of factors. I doubt anyone really knows how it all works together long term just yet. It can't be simplified the way we would like to believe.

 

[DianaCox]

I am 11 years out. I have never needed Vitamin A supplementation. I didn't need Vitamin D until 5 years out. I have carefully tweaked it, and have now managed to get it up to 88 by taking 500K IU/week (one every night, an extra one in the AM 3 days a week). I have supplemented with 1300 mg of calcium/day the whole time, and my PTH this time was 35. And I'm back to just a smidge over 200, after getting down to 169 at 6 years out.

Yes I eat too many carbs (i.e., the weight), but I also think I'm absorbing them and fat (and thus other things as well) better than many, because (and I'm NOT complaining, mind you!), I have a very easy time keeping my levels good, and only take my vites twice a day (plus my levoxyl in the middle of the night).

It's a trade off - I'm kinda fat, but not as fat as I was, and WAY WAY WAY healthier than I was pre-DS. I'm pretty much OK with that - even though I'd still like some of the excess poundage to magically go away with no effort on my part.

 

[BigIsland Tammy]

My common channel is 150. My total (original) length was the 2nd longest in the LabRat listings (no longer available) and I am kinda tall for a women of my generation. So, as EN pointed out, its all relative to what you started with.

Your surgeon giving consideration to all these factors, and more - that's a good thing. Talk with him about your body and health and how well you expect to take care of yourself and adhere to a DS-life. Some specific answers he may not have until you're in surgery...so be sure to agree on starting points, minimum expectations, and the desired goals.

 

[Parousia]

Some very interesting observations and experiences here. It would be great to have more clear answers, but I guess the human body is just too complex to have things black and white.

I do wonder why the original length of the intestines makes a difference, because I would have thought it would just be how much is left to absorb nutrients through that would matter. I wonder if the total (original) length bears any relationship to our heights. Then it would make more sense to me, I think. Something to Google, I guess, lol. I'm not questioning that the original length makes a difference, btw. Just wondering why it would.

I'm all of 5'1", btw. So, a shorter CC was probably the way to go for me, come to think of it, quite apart from any consideration of the original length of my small intestines.

 

[Parousia]

...I think DSers as a whole would be more successful if their surgeons spent just a little more time figuring out their patient's real needs. Maybe some kind of a patient questionnaire to try to give some more insight to the doctor. It's easy to just assume I am fat because I eat too much but there are at least 2 sides to every story.

I absolutely agree with you, @Munchkin! Too many people assume that if you're fat you just eat too much (and so, by extension, it is all your own fault, and they shouldn't have to pay your medical bills, yadda, yadda, ya). Most people (including far too many doctors) don't seem to realise that obesity is a complex issue, and even for those who are obese because of overeating, they're generally not overeating because they're just gluttons. Both physiological and psychological factors (more often a combination of the two, I believe) can cause overeating. People cannot and should not just be reduced to caricatures, but sadly, that happens all the time.

But then, there are also plenty of MO people who don't overeat, compared to the average normal weight person. I probably am (was?) a superabsorber @Munchkin (although I've never heard the term before). I've always been a small eater, to the extent that people would comment on it. My mother always told people I ate like a bird (and yet, I was the fattest in my family, even as a child). When I've mentioned my small appetite to doctors over the years, I could always see their eyes glazing over and it was clear they thought I was either lying to them or deceiving myself, and actually eating far more than I thought I was, without realising it. That's not to say I didn't have the occasional binge, but they were few and far between, and plenty of people binge occasionally without exploding into a blimp! When I saw a dietician prior to my lapband surgery, I had to keep a food diary for two weeks to show him. I wanted to be brutally honest with it, and not change my eating patterns to make it look good. One day in the two weeks I had a snack size chocolate, but other than that, it was quite clear from my diary that I ate less than most people. I thought the dietician would comment on that and would see that I must have a biological/genetic problem of some sort. But no: all he talked about was the chocolate! Maybe he thought it was just the only one I would admit to, lol.

Anyway, apologies for the digression, lol. Sometimes long-held resentments and hurt come out when you least expect it. I'm sure we all carry some baggage from our lifetimes of being treated as "less than" by others, including professionals who should be there to help us.

 

[DuodenalSwitchaRoo]

I'm not unhappy with my overall weight loss, but it has slowed right down. 2/3rds of it occurred within the first couple of months. I'm losing at a rate of between 1 and 2 lbs a week now, although some weeks I don't lose at all. From what I've heard and read, that is very slow so early out. I'd love to hear what your (and others) experience has been, though .

ME TOOOOO!!!!!!! I thought I was/am doing something terribly wrong so I went away to hang my head in shame (alone). It's so slow now that Im sad But when I just looked at my MFP profile and realised how much has gone since Feb...and my pounds may be a bit higher but your % of EWL is WAYYY higher I think you have done super awesome

I'm struggling massively with hunger...not head hunger, proper I could eat my right arm type of hunger. It's the cycle of the hormone dumping with me Im sure. :/ But we WILL get there I do know of a few people who have minded their P's and Q's and still lose (very slowly) 3-5 years post op. We got this DS twinny!

 

[Parousia]

ME TOOOOO!!!!!!! I thought I was/am doing something terribly wrong so I went away to hang my head in shame (alone). It's so slow now that Im sad But when I just looked at my MFP profile and realised how much has gone since Feb...and my pounds may be a bit higher but your % of EWL is WAYYY higher I think you have done super awesome

I'm struggling massively with hunger...not head hunger, proper I could eat my right arm type of hunger. It's the cycle of the hormone dumping with me Im sure. :/ But we WILL get there I do know of a few people who have minded their P's and Q's and still lose (very slowly) 3-5 years post op. We got this DS twinny!

Thanks Roo . I'm very glad you came back again. I've been wondering how you were going. You certainly have nothing to be ashamed of! You're doing really well. We, as women, do have more to deal with with the whole hormonal thing. That can really mess you around. Just try to stuff yourself with protein and fat to satisfy the hunger, then whatever carbs you have shouldn't do much harm. I'm trying to increase my protein and fat intake, to see if that will help with my weight loss. I haven't been particularly hungry, but I have been having lots of carb cravings lately, which are quite hard to deal with. I've been dying for some breakfast cereal, of all things. Problem is, even when I have a little to try to satisfy the craving, I don't really enjoy it, so remain unsatisfied. All that said, we've definitely got this, Twinny!

 

[Parousia]

Thanks so much @4KidsAndaDog . I'll try to get hubby to take a photo for me to post. I just haven't got the hang of selfies, unfortunately. Not quite coordinated enough, I think, lol.

 

[Pamela]

Just another example. My CC is supposedly 75cm, pretty short. And I never reached goal and I'm still fat. I will never see a normal BMI. I wish I was made of money so I could get the whole thing redone. I have serious doubts that my CC is really 75. I would bet it's much longer. Why? Because I am still fat and I have never had any vitamin/supplement deficiencies.

We are all different and it makes sense to me the surgery should be tailored to our individual needs. These are just my observations but I think women almost always need more oomph to their DS than most men. Also shorter women seem to need more help than tall ones. People with larger BMI's and more pounds to lose need more help too. If you can honestly say you can gain weight on 1000 cal per day you are probably a superabsorber. One of those people who would survive a famine. Superabsorbers need more help as well. And quite a few of the larger BMI folks are superabsorbers.

I think DSers as a whole would be more successful if their surgeons spent just a little more time figuring out their patient's real needs. Maybe some kind of a patient questionnaire to try to give some more insight to the doctor. It's easy to just assume I am fat because I eat too much but there are at least 2 sides to every story.

 

[Pamela]

Hi Munchkin,
I am 75cc too. I am facing the same problems as you. I'm 5'1/194lbs starving but gaining!!!