DS Math

[DianaCox]

Alex Brecher "just started" a DS board? Bwahahahaha - he's been "trying" to start one for years. Nobody worthwhile will join, because the smart DSers don't need him. We're here.

 

[KathrynK]

The science just isn't there. This is marketing of an unproven drug delivery system, and everyone should know that no vitamin patches have been rigorously evaluated or approved by the FDA. Getting a predictable and high enough dose of anything though the skin is extremely challenging, even for the pharma company that spent hundreds of millions of dollars perfecting the nicotine patch, which is for short term use only. Unlikely that these vitamin companies have spent an equivalent amount researching the success of vitamin delivery through different skin types, at various ages, in different climates, and with different vitamins and minerals. When it is for long term use, you have to also add in changing dosing needs over a lifetime.

I know there is a lot of money to be made in this. It concerns me that even oral vitamins are not monitored by the FDA for purity, safety and concentration, and this adds the unpredictability of dosing via the transdermal delivery.

I wouldn't venture to promote or sell this unproven technology, at any price, for a DS patient. We aren't just casual vitamin users whose health doesn't really depend on the successful delivery of the right dose.

 

[Laney B]

thank you so much for this info!! esp about how one relates to sweets after... i have had problems with yeast beast and i'm hoping that this surgery and the high protein high fat diet will kill that dead!!

 

[southernlady]

thank you so much for this info!! esp about how one relates to sweets after... i have had problems with yeast beast and i'm hoping that this surgery and the high protein high fat diet will kill that dead!!

Don't count on surgery killing it. I still adore bread. I just don't like how I feel when I ingest TOO much...but TOO much is subjective...my TOO much is probably way more than someone elses. I still eat bread products, just keep a running total in my head (based on 2 decades of carb counting) to know when I have reached my limit. MY limit is around 100-150 carbs...others limit themselves to 50 and we are talking total not net (voodoo math).

 

[Icequeen]

Reposting my article from DSFacts.com:

This is to explain the "DS Math" for those wondering how DSers can eat 3000+ calories per day and not gain weight. Some people also seem to have difficulty understanding why our arteries aren't clogging up, since most of us eat about 50% of our calories as fat. For those of you who are interested, this is how the math works.

Note that in this DS math explanation, while the 80% fat malabsorption had been documented by a study by Gagner et al. [68], the 40% malabsorption figure I use for both complex carbohydrates and protein malabsorption are only estimates, and are probably quite a bit more variable person-to-person than the fat malabsorption, because there is SOME digestion and absorption of protein and complex carbs in the small intestine as the result of acid digestion by the stomach and enzymes secreted in the mouth and the jejunum and ilium, together with the much more variable length of the alimentary tract between patients, whereas fat digestion and absorption essentially only occurs in the common channel. The 40% figure comes from conservatively averaging a number of figures -- guesstimates, really -- that I have read and heard from surgeons over the years. These numbers are rough estimates for the purpose of explaining generally how the DS works - these numbers are NOT intended for you to use with any hope of accuracy. And not only will each individual vary in their malabsorption from another person, but each individual's malabsorption will vary over time. This is for illustrative purposes only!

I (and many if not most DS post-ops over 2 years out) eat about 3000 cal/day most days. But we don't absorb that much, of course. This is the "magic" and the pleasure of how the DS works, and why it works. The DS math of malabsorption looks something like this:

I always get about 100 g of protein/day (I have never had protein shake -- since surgery; I have eaten all my protein as food). 100 g of protein x 4 cal/g = 400 cal eaten; x 0.6 (60% of protein absorbed) = 240 cal from protein absorbed.

Since I eat at least 50% of my calories as fat (full fat mayo to my heart's content; butter with my seafood and veggies; full fat salad dressing, and lots of it, with my salads and veggie dips; nice marbled meats including steak, bacon and crispy chicken skin), let's call it 1530 calories which equals 170 g of fat (fat is 9 cal/g) to make the math easier. But I absorb only 20% of the fat I eat, for only 306 cal from fat absorbed.

So, fat + protein eaten = 1930 calories of the 3000 I eat per day. That leaves 1070 cal or 267.5 g of carbs (4 cal/g). But I only absorb about 60% of complex carbs. I have to account for sugar first, because I do absorb 100% of sugars -- I would guesstimate that I eat about 50 g of sugar/day x 4 cal/g for 200 calories from sugar absorbed; of the remaining 870 calories of complex carbs x 0.6 (60% absorbed) = 522 cal from complex carbs absorbed.

Here is the DS math. My ABSORBED calories from 3000 ingested calories (eating 100 g of protein, about 50% fat and the rest carbs) is:

240 calories from protein
306 calories from fat
200 calories from sugars
522 calories from complex carbs
1268 calories absorbed per day from eating 3000 calories

And that is why I (and other DSers) can eat like that, not exercise, and still be either maintaining or losing weight. It doesn't suck!

(Note: I didn't include alcohol, which is FULLY absorbed and 7 cal/gram - and is usually accompanied by more fully absorbed calories. You are warned!)

To be clear, I am NOT advocating not exercising! Everyone needs exercise for cardiovascular health, bone health, looking toned, etc. My point is, exercise for losing or maintaining weight loss isn't as necessary for most DSers.

As for arteries clogging from all that fat -- what doesn't get absorbed doesn't get to my arteries, of course! My total cholesterol is 167, my HDLs are 53, and my LDLs are 95. My triglycerides are 95. All of which numbers are EXCELLENT -- my doctor wishes her levels were that good. My CRP (an indicator of inflammation and thus cardiovascular risk, especially in women), which was a dangerous 10 times normal pre-op, and which was not helped much by statins, is now completely normal with NO statins. My cardiologist released me -- there is no need to see him anymore!

Note that contrary to unfounded accusations, I don't eat huge amounts of food at a time (nor do most of us) -- I do eat smaller, higher calorie meals (full of yummy fat!), and I eat 4-6 times/day. I didn't binge pre-op, and I don't binge now. I usually get at least a snack if not an entire second meal out of a restaurant meal, which for me is generally sharing a couple of appetizers with my husband, sometimes a piece or two of bread with LOTS of butter, an entree of my own, and sharing a dessert, along with a drink (Mai Tai!). I usually take home some of one of the appetizers, and half of my main course, and finish it off before bed or for breakfast the next day.

I didn't have a major sweet tooth pre-op, but I eat even fewer sweets now -- the DS changes metabolism to correct insulin resistance, and after 2-4 bites of something sweet, I am generally done. I am satisfied with fewer sweets than I was pre-op -- sweets taste DELICIOUS for a couple of bites, and then taste overly sweet. I get both the pleasure of having sweets with no repercussions, and no fear of overindulgence. Sometimes, when I feel inclined to indulge but find myself physically not wanting more, this is almost amusingly annoying. No willpower needed!

By the way, based on studies on people with short bowel syndrome, intestinal adaptation is generally complete by about 2 years out. The statistics of weight loss maintenance over 10-15 years with the DS supports the theory that the same is true for DSers -- if there was continued adaptation of the intestines after two years, there would likely be significant and ongoing weight gain in long term DSers, which there generally isn't. But slowing down as we age probably DOES put us at risk - just like anyone else.

I'm coming here looking for advice. I'm a year out from DS and I stopped losing at 14 weeks post op (and that was only 40ish pounds). I have never struggled so much to lose weight in my life. I have tried EVERYTHING. I've tried bumping my calories up to 3k, dropping my calories to 1200 (that's before malabsorption) the scale doesn't budge. I still have 90 pounds to go! I always waiver within the same 5 pounds. I weigh every morsel that goes in my mouth so there is no estimation of intake. I have to eat 180g of protein a day to keep my protein labs in normal range, so I know the malabsorption is working (also I have clear evidence the fat malabsorption is working from the sheen in the toilet and my rapid cholesterol drop). I feel like the only patient on the planet that struggles to lose with DS. My primary care doctor started me on zepbound a couple of months ago and the scale is moving, but only because I physically can't eat so I'm consuming less than 1k calories a day which I know is not good for me, horrible for my metabolism and causing me extreme fatigue - it's not sustainable (along with the pricetag because my insurance wont cover it) Anyone have any suggestions?

 

[southernlady]

Anyone have any suggestions?

What are your exact macros? Protein you mentioned but fat you didn’t mention grams, carbs, hydration.

 

[Mystrys]

I'm coming here looking for advice. I'm a year out from DS and I stopped losing at 14 weeks post op (and that was only 40ish pounds). I have never struggled so much to lose weight in my life. I have tried EVERYTHING. I've tried bumping my calories up to 3k, dropping my calories to 1200 (that's before malabsorption) the scale doesn't budge. I still have 90 pounds to go! I always waiver within the same 5 pounds. I weigh every morsel that goes in my mouth so there is no estimation of intake. I have to eat 180g of protein a day to keep my protein labs in normal range, so I know the malabsorption is working (also I have clear evidence the fat malabsorption is working from the sheen in the toilet and my rapid cholesterol drop). I feel like the only patient on the planet that struggles to lose with DS. My primary care doctor started me on zepbound a couple of months ago and the scale is moving, but only because I physically can't eat so I'm consuming less than 1k calories a day which I know is not good for me, horrible for my metabolism and causing me extreme fatigue - it's not sustainable (along with the pricetag because my insurance wont cover it) Anyone have any suggestions?

I’m definitely watching for answers to your questions! I’m 8+ years out from my TDS, I have gained about 30 pounds after a two year bout with SIBO and have tried EVERYTHING since December 2023 to drop it. The scale has not budged!! I’m literally eating 1000-1400 calories a day and not seeing an ounce drop off that scale. I tried all the usual stuff and have never been at more than 50 carbs in a day since starting…most days are 25-40. In fact…I’ve been low carb/keto for the last 17 years with a few weekly seasonal “breaks” between Thanksgiving and Christmas. I refuse to use any of the GLP1 drugs because I don’t have enough of an understanding to feel comfortable with the mechanism and how it could react with our altered anatomy. I just don’t think there’s enough long term studies into short gut health on it to feel safe. That’s just me. Something that slows down movement in there just sounds like a catastrophic mess waiting for me! I struggled with constipation more than a little after my DS. Not looking for that ever again. I’m not able to exercise like before due to multiple injuries and several surgeries over the last few years so I know that’s not helping. But given the anatomy changes this struggle seems counter intuitive and I’m at a loss how to get this weight off. The reason I really started in earnest in December is because i have a second round of plastics coming up mid May and now I’m battling keeping my protein super high going into surgery and being able to drop anything on the scale. It’s incredibly frustrating. I even joined a DS regain group on FB for guidance. I thought 5-6 months would be enough for me to drop at least 20…nope! Not an ounce! So the DS math does not work for me and my anatomy must have fully adapted to a much lower level of necessary caloric intake

 

[Icequeen]

What are your exact macros? Protein you mentioned but fat you didn’t mention grams, carbs, hydration.

Protein 180
Carbs 60
Fat 75

I've had to cut down fat to try and drop my total calorie levels to a place that the scale will move. Unfortunately, that appears to only happen when I hover closer to 1k calories - which is absurd. While i have those macros and I do everything I can to hit protein every day, I rarely hit the other 2. I drink between 120 and a gallon a day.

 

[Icequeen]

I’m definitely watching for answers to your questions! I’m 8+ years out from my TDS, I have gained about 30 pounds after a two year bout with SIBO and have tried EVERYTHING since December 2023 to drop it. The scale has not budged!! I’m literally eating 1000-1400 calories a day and not seeing an ounce drop off that scale. I tried all the usual stuff and have never been at more than 50 carbs in a day since starting…most days are 25-40. In fact…I’ve been low carb/keto for the last 17 years with a few weekly seasonal “breaks” between Thanksgiving and Christmas. I refuse to use any of the GLP1 drugs because I don’t have enough of an understanding to feel comfortable with the mechanism and how it could react with our altered anatomy. I just don’t think there’s enough long term studies into short gut health on it to feel safe. That’s just me. Something that slows down movement in there just sounds like a catastrophic mess waiting for me! I struggled with constipation more than a little after my DS. Not looking for that ever again. I’m not able to exercise like before due to multiple injuries and several surgeries over the last few years so I know that’s not helping. But given the anatomy changes this struggle seems counter intuitive and I’m at a loss how to get this weight off. The reason I really started in earnest in December is because i have a second round of plastics coming up mid May and now I’m battling keeping my protein super high going into surgery and being able to drop anything on the scale. It’s incredibly frustrating. I even joined a DS regain group on FB for guidance. I thought 5-6 months would be enough for me to drop at least 20…nope! Not an ounce! So the DS math does not work for me and my anatomy must have fully adapted to a much lower level of necessary caloric intake

I'm currently on zepbound and it's the only time since 14 weeks post op that has moved, BUT, I'm barely getting 1k calories because the food aversion is REAL and the hunger is non-existent. I have to force protein protein shakes down before bed to make sure I hit my protein number for the day. If I don't my protein labs tank

 

[southernlady]

Protein 180
Carbs 60
Fat 75

I've had to cut down fat to try and drop my total calorie levels to a place that the scale will move. Unfortunately, that appears to only happen when I hover closer to 1k calories - which is absurd. While i have those macros and I do everything I can to hit protein every day, I rarely hit the other 2. I drink between 120 and a gallon a day.

Try cutting your carbs lower and raising your fat.

 

[Icequeen]

Try cutting your carbs lower and raising your fat.

I'm not coming close to that carb number currently. My actual carb intake is closer to 20. since starting zebound I barely eat. I force myself to drink shakes to meet my protein, but my carbs and fats are way low. I will say, in the last year I have tried EVERY macro combination you can imagine. I tried consuming 3k calories a day with 100g of fat - I tried upping carbs (that helped with energy) I tried lowering carbs. Unfortunately, carbs don't seem to have any impact in weight loss for me. I can eat 100 or 20 and there is no difference on the scale. It seems the scale only moves when I'm around 1k calories - which is hardly anything absorbed.

 

[southernlady]

I'm not coming close to that carb number currently. My actual carb intake is closer to 20. since starting zebound I barely eat. I force myself to drink shakes to meet my protein, but my carbs and fats are way low. I will say, in the last year I have tried EVERY macro combination you can imagine. I tried consuming 3k calories a day with 100g of fat - I tried upping carbs (that helped with energy) I tried lowering carbs. Unfortunately, carbs don't seem to have any impact in weight loss for me. I can eat 100 or 20 and there is no difference on the scale. It seems the scale only moves when I'm around 1k calories - which is hardly anything absorbed.

Do you have a copy of your operative report? That may help you.

 

[Icequeen]

Do you have a copy of your operative report? That may help you.

Yes, my cc is 150.

 

[Icequeen]

Yes, my cc is 150.

Do you have a copy of your operative report? That may help you.

I really wonder sometimes if my surgery was done correctly. I know I'm malabsorbing because my cholesterol nose dived after surgery and has stayed good (it was 289 pre op and now it's 141) and my a1c dropped from 5.8 to 5.2 - and if I don't stay in the 180 protein range my labs tank - so I know something is working - plus I have the typical DS weird colored poop and the oil skims in the toilet. BUT... I don't have gas or loose stool like so many other people do. Even when I tried going back to the macros I ate before surgery that I could lose weight on (which came out to 1700 calories and I lost pretty consistently with that) my carbs were 165g and I had no tummy issues, whereas everyone else I talk to who's had a switch said that would send them running to the toilet or they would have gawd awful gas.

 

[southernlady]

Even when I tried going back to the macros I ate before surgery that I could lose weight on (which came out to 1700 calories and I lost pretty consistently with that) my carbs were 165g and I had no tummy issues, whereas everyone else I talk to who's had a switch said that would send them running to the toilet or they would have gawd awful gas.

There are some of us who are outliers with carbs. Generally we recommend 30-50 total carbs during the losing phase but there are some of us who don’t lose that way. I was averaging 100-150 grams a day and losing.