What's the deal with not drinking while eating?

[OldBroad]

The advice from Dr. Elariny's office is don't drink while you are eating, for 15 minutes before you eat, and for an hour afterwards. Can someone explain the logic (if any) of these instructions? This is confusing, especially when "eating" and "drinking" are basically the same thing during the liquid and pureed food parts of the diet progression.

 

[DianaCox]

Those are essentially RNY instructions - RNYers have no pyloric valve, and when they drink, it washes the food out of their pouch, through the stoma and into the intestine. In order to feel full, they have to have a dryish, pasty mass in the pouch to make it stick around. As usual, stupid, wrong instructions for DSers.

BUT - it SLIGHTLY makes sense in the immediate post-op period. Your sleeve is very small and swollen right now, so when you drink before eating, you fill your sleeve with low-nutritional-value fluid (for a little while) and can't fit in much nourishment in the form of food (pureed or otherwise). And if you drink much while you eat, you are not going to be able to eat as much (again, you need to be able to get in as much nourishment as you can). That doesn't mean you CAN'T drink with your meals, because it is not going to wash the food out of your pouch through your stoma - because you don't have either of those dysfunctional butchered arrangements. It means you won't be able to eat as much at one sitting, and you won't feel as full an hour or so later, because a more liquid bolus in your sleeve is going to get discharged through your pylorus little faster than a thicker slurry that isn't so watered down.

So, probably for now, don't drink much before you intend to eat, or drink much with it (if you feel like you need to take a sip between bites, as I always do, you can - just make it a small sip), because it will lessen the amount you can put in there at once. But it is not an absolute rule for DSers.

And I don't pay any attention to it now - except that I still only sip while eating, so I can eat more protein at once. For RNYers, it is for life - and I cannot imagine eating without being able to drink - it was one of the many reasons I refused to even consider RNY.

 

[Munchkin]

Basically, that's RNY advice. If they drink and eat at the same time it washes the food out of their 'pouch' and they get hungry faster. You have a fully functioning stomach with a pyloric valve. DSers can eat and drink, however, especially in the beginning, drinking seriously limits the amount of protein you have space for. You have to use your stomach space wisely.

Right now you aren't getting any real food so none of this matters!

 

[DianaCox]

@Munchkin: Jinx, you owe me a Fresca.

 

[Charris]

@DianaCox I didn't realize you were never a Rny.

 

[OldBroad]

@DianaCox I suspected that this was not relevant advice for the DS, but didn't realize why. The amount of RNY-related misinformation in the post-surgical recommendations I'm getting from Elariny's office is giving me some anxiety. I know I'm going to have to advocate for evidence-based follow-up care, but I would have thought that it wouldn't be such obvious things, so much of it, etc.

 

[southernlady]

@DianaCox I suspected that this was not relevant advice for the DS, but didn't realize why. The amount of RNY-related misinformation in the post-surgical recommendations I'm getting from Elariny's office is giving me some anxiety. I know I'm going to have to advocate for evidence-based follow-up care, but I would have thought that it wouldn't be such obvious things, so much of it, etc.

Unfortunately that is true of almost EVERY surgeon's office out there. And it is why this forum is SO critical...to have a central location to compile information, both scientific and personal.

 

[Purple Frog]

Unfortunately, this is true of my drs office as well.
A lot of the information is obviously RNY in my post-op "handbook".

I just had this convo yesterday on a FB board. I am going to scream if people don't stop calling our stomach a "pouch" and posting the youtube video of apple sauce going through the funnel.

 

[DianaCox]

If you see something you don't understand, ASK. If you ask here, someone else may benefit from the answer as well.

Most surgeons' offices are giving lousy post-DS advice. We are ALL concerned about it, especially since it is without a shadow of a doubt contributing to DS "failures" and illnesses. I am trying to get some interest among the DS surgeons to LISTEN to the vets, and to do studies empirically studying whether what we are saying is true. It is difficult to give cookie cutter advice for ANYONE, because our results are individual and change over time, but you have to know what to test for, and how to interpret the results and what to do to fix them.

For example, "DSers get diarrhea from eating too much fat." That is WAY oversimplified, and it is highly likely that this is NOT the first thing to suggest when someone has diarrhea. But even before that - WHAT IS DIARRHEA IN A DSer?" It is NOT pooping more than 5 times a day - for some people, that's normal. It's LOSING WATER - that's diarrhea. If you're pooping nice pudding-y DS poop, it's not diarrhea. And more likely than not, it's NOT fat that's causing it - it is (1) sugar alcohols; (2) wheat; (3) tomatoes or spinach or whatever your guts don't like today; (4) bacterial overgrowth. Or something like that. If you have an OIL SLICK in the toilet as well as loose watery stools, then and only then is it likely that you should back off the fat a bit (and the tomatoes).

There are dozens of correlations and suggestions (I hesitate to say "rules") like this, and if the doctors would take the time to learn them, I think the DS would have a far better reputation. They are not hard to understand, but they are things that we DSers have learned from experience, not from extrapolating medical knowledge from other surgeries or malabsorptive disorders that DON'T APPLY TO US.

Can you tell this is something I'm passionate about? I was trying to get Dr. Gagner to pay for me to speak on this topic at his first DS consensus conference in Montreal in June (http://www.bariatricnews.net/?q=event/111747/international-consensus-conference-duodenal-switch), as he invited me (more or less) to attend, but he said he could not.

 

[OldBroad]

I was trying to get Dr. Gagner to pay for me to speak on this topic at his first DS consensus conference in Montreal in June (http://www.bariatricnews.net/?q=event/111747/international-consensus-conference-duodenal-switch), as he invited me (more or less) to attend, but he said he could not.

So, where is your GoFundMe page? How much do you need?

 

[DianaCox]

I just started looking around for more information about this meeting - NONE of the ASMBS site notices includes a link, and I finally stumbled upon the link to the conference - which is so "understated" as to be useless. Not even an agenda posted: http://www.dsconsensus.com/. I'm wondering if he has enough interest to actually pull it off. I

Back in January, I got involved in a discussion on LinkedIn of all places, in a thread for the ASMBS as a group. After some of my posts about nutritional issues being the surgeon's failure more than the patients', for lack of proper guidance, he said:

Diana, good suggestions. As a matter of fact, we will have the First International Consensus Conference on Duodenal Switch in Montreal, June 22-23, 2015 (Omni Hotel). If interested to participate or present, please email me: [email protected]​

I sent him several emails to discuss this, but I can't afford to go - and I think Larra should go too. I sent this to him last month:

Anything new on this subject? I still cannot afford to come at my own expense, but I certainly would like to do anything possible to support the need for proper studies on nutritional requirements for DSers.

And, by the way, support a resolution about people getting PROPER information about the SADI, not calling any name that includes duodenal switch, and promulgating proper information that nutritional requirements for the SADI are very different from DS - we vets are seeing some TERRIBLE stories on the message boards.​

His response: "The first conference (2015) will be an expert opinion, with invitations, as we have a limited budget. Subsequent ones will have an open submission of abstracts, videos and presentations, in 2016."

So, maybe next year - if there is a Second International Consensus (assuming the first one happens).

OTOH, a couple of days later, there is this, in Las Vegas: http://owe.asmbs.org/schedule/
This would be fun to attend: http://owe.asmbs.org/courses/bariatric-surgical-debates/

 

[k9ophile]

Teehee. I spoke at a seminar at my surgery center as a patient living with WLS. One question about the DS was about drinking with meals. I said I did, but not very much as with limited capacity, I'd rather eat. Told the truth and got the stink eye from the program coordinator. That no drinking for a while was a factor in choosing the DS. I don't eat by the clock.

 

[DianaCox]

How dare you enjoy living with a bariatric surgery!

 

[aaa]

That Vegas program does look interesting.