Theory on why I can eat so much and still struggle to maintain weight.

[DSRIGGS]

I have wondered for quite sometime now why it is that I can eat such big volumes compared to most DS patients and struggle to maintain my weight/nutrition* and or even gain a little weight. For instance I just finished dinner and had:

• 8 oz sirloin steak
• 2 skewers of grilled shrimp
• Entire small to medium baked potato with butter and sour cream
• Half of the steamed broccoli that came with it
• 75% of the rice pilaf upon which the skewers were resting
• A piece of cake my wife had made for work

I will be hungry within the hour an will probably wake up mid morning hungry and looking for a snack.

So a couple of theories I have as to why I can eat so much:

1. My body simply knows I need the nutrition and is telling me to eat.
2. My pyloric valve and stomach for some reason release my stomach contents early compared to other people and this is actually a partial cause of my malnturtition struggles because my stomach isn't getting the food broke down enough for absorption in my small intestine.
3. My stomach has stretched (I really don't think that is the case but I don't know for sure....imaging I have seen of my guts and stomach don't show anything that looks like anything other than the small DS stomach I have seen in general diagrams and imagery)

Any thoughts on my theories? I honestly think it is a combination of items 1 & 2, but who knows. Thanks







* I absolutely do not care what my actual weight is. I simply use my weight as a proxy for where my key nutritional values are trending (up being good, down being bad). Nutrition and feeling well is all I care about and if that nutritionally health weight ends up being 175 lbs or 210 lbs I really don't care.

 

[southernlady]

Absolutely no clue here. I just can't fathom an 8 oz steak these days...a 6 oz is the most I can manage (even tho my brain wants more). I hope you find your answer.

 

[Razbry]

My personal thought is that things (for whatever reason) are moving faster in your guts. Periodically I experience what I call "magic" days, where I can eat like there is no tomorrow. I enjoy it, because eventually my body slows it all down.

 

[duh_Mom]

no help here either Scott - your theories seem logical - I agree that #3 is not likely. #2 would certainly seem to increase the number2 that you struggle with. I wonder if there is a test for a functioning pyloric valve. . . who knows, but I can feel your frustration.

 

[Marquis Mark]

Wow. That's an enormous amount of food for someone with a DS stomach. My stomach was highly stretched, too, which is what made me convert from a sleeve to a DS, but I never had that kind of capacity (see attached photo of my stretched sleeve, -- huge fundus -- f you're interested). Based on all of that, #1 in combination with #2 sounds most likely. But what sends those "let it through" signals to the pylorus? The answer could be elsewhere in the digestive system.

You and your son have gone through so much. I certainly hope you find some answers.

 

[DSRIGGS]

Wow. That's an enormous amount of food for someone with a DS stomach. My stomach was highly stretched, too, which is what made me convert from a sleeve to a DS, but I never had that kind of capacity (see attached photo of my stretched sleeve, -- huge fundus -- f you're interested). Based on all of that, #1 in combination with #2 sounds most likely. But what sends those "let it through" signals to the pylorus? The answer could be elsewhere in the digestive system.

You and your son have gone through so much. I certainly hope you find some answers.

Thanks for the well wishes Mark. I will be fine an Cameron's condition has improved immensely since having his surgery with Dr K to put in the Roux en Y drain. His stomach was only about 30% emptied after 4 hours, and it should have been gone after an hour As far as my emptying my understanding is that the pyloric valve knows to open when food reaches a liquid like state. That being said, cameron's emptying issues were due to have vagal nerve being cut by a surgeon when repairing that surgeons' failed nissen fundoplication on Cameron...so not sure if the vagus nerve senses the resistance the stomach faces when "grinding the food" and then sends a signal once resistance is lower, or how it plays a part. In any case if I was rapid emptying I would think I would have dumping syndrome, but I don't get dumping symptoms.....so who knows what the deal is. If I am emptying quickly that means Cameron and I were on opposite sides of the spectrum in that regard if so....

In looking at your photo it almost looks like you had a huge hiatal hernia? If the big wide spot on top is truly your fundus, because I see what seems to be esophagus in between the two hot white spots. Am I looking at that incorrectly?

When I had an egd late last year the GI thought I had a large hiatal hernia but on a barium swallow imaging showed a very small hernia, so my stomach is still well in tact from what I have seen. I suspect my volume is in the 8-10 oz range now at most, as it was 4-5 oz after my DS and I am told this part of the stomach just doesn't stretch that much so I can't imagine it being any bigger than that 8-10 oz range.

 

[Marquis Mark]

In looking at your photo it almost looks like you had a huge hiatal hernia? If the big wide spot on top is truly your fundus, because I see what seems to be esophagus in between the two hot white spots. Am I looking at that incorrectly?

I've never had a hernia fortunately. As you know, you have to drink the liquid as they take the picture, so I think the esophagus looking thing is actually the middle of my sleeve. It just didn't have any contrast material going through it when the picture was taken. The doctor, of course, blamed me for stretching my sleeve. Maybe I'm in denial but I find that hard to believe since I never got bigger than a 40 BMI and was never a power eater, but people that were much larger than me and were hardcore over eaters didn't stretch theirs?! I also think the fact that the Kaiser doctor didn't argue with me when, at a 37 BMI, I said I wanted a revise to the DS and instead put me right through to Dr. Belzberg is a tacit admission that he may have left too much fundus. Also, the fact that my weight loss stopped at 40% EWL at 6 months out tells me the original VSG surgery was sub-optimal.

In any case, Dr. Belzberg trimmed off the extra fundus when he did my DS and I can definitely feel much greater restriction now. Feels like I can only eat about a third of what I could with my old VSG.

8-10 ounce range and you can put that much food in it? Wow, yes, it must be flushing it through very quickly. You had Dr. K trim your sleeve, right? How long did it take to go from the 4-5 ounce post Dr. K capacity to where you are now? I'm asking because I'm only two months out but can already put down 3,000 cals/day if I want. Of course, since my sleeve was only trimmed (required only 2 staples fires) I imagine there was less swelling and healing...

 

[DSRIGGS]

I've never had a hernia fortunately. As you know, you have to drink the liquid as they take the picture, so I think the esophagus looking thing is actually the middle of my sleeve. It just didn't have any contrast material going through it when the picture was taken. The doctor, of course, blamed me for stretching my sleeve. Maybe I'm in denial but I find that hard to believe since I never got bigger than a 40 BMI and was never a power eater, but people that were much larger than me and were hardcore over eaters didn't stretch theirs?! I also think the fact that the Kaiser doctor didn't argue with me when, at a 37 BMI, I said I wanted a revise to the DS and instead put me right through to Dr. Belzberg is a tacit admission that he may have left too much fundus. Also, the fact that my weight loss stopped at 40% EWL at 6 months out tells me the original VSG surgery was sub-optimal.

In any case, Dr. Belzberg trimmed off the extra fundus when he did my DS and I can definitely feel much greater restriction now. Feels like I can only eat about a third of what I could with my old VSG.

8-10 ounce range and you can put that much food in it? Wow, yes, it must be flushing it through very quickly. You had Dr. K trim your sleeve, right? How long did it take to go from the 4-5 ounce post Dr. K capacity to where you are now? I'm asking because I'm only two months out but can already put down 3,000 cals/day if I want. Of course, since my sleeve was only trimmed (required only 2 staples fires) I imagine there was less swelling and healing...

Mark I went to Dr K for a revision for malnutrition, not because I wasn't losing enough. He increased my absorption so no he didn't touch my sleeve nor would I have allowed him to do so. The sleeve doesn't have much bearing on long term DS weight loss. It is the switch that makes the DS work. A sleeve kick starts the weight loss for a DS but it is the switch that works......

I like being able to eat and hated, I mean hated it early on because I couldn't eat anything. I don't try to eat a lot now at one sitting, I just eat until full. I can't eat anywhere near what I could pre-ds. When I have my four eggs with slice of toast and deli meat with cheese in the morning. That fills me up to the point where the last bite or two are as much as I can eat.( Before the DS I could have eaten 3-4 times that if I wanted too... I didn't) Then 60-90 minutes later I am ready for breakfast two.

 

[Marquis Mark]

I've read your story and know about the malnutrition problem you went to Dr. K for. I don't know why I thought you had the sleeve trimmed. Must have got you mixed up with someone else. 4 eggs, toast & deli meat? With your malnutrition issue, I guess that capacity iss a good thing. I'm up to maybe two eggs and a slice of toast now. But if I just wait 20-30 minutes I can do it again.

 

[DSRIGGS]

I've read your story and know about the malnutrition problem you went to Dr. K for. I don't know why I thought you had the sleeve trimmed. Must have got you mixed up with someone else. 4 eggs, toast & deli meat? With your malnutrition issue, I guess that capacity iss a good thing. I'm up to maybe two eggs and a slice of toast now. But if I just wait 20-30 minutes I can do it again.

No problem.

BTW, at your stage I wouldn't have been able to eat the toast at all.. It was too bloating and maybe two eggs Max was what could have eaten... And they had to be sunny side up only. Scrambled were like lead balloons.. Crazy how much it has changed. It was probably a year out before I could eat toast or bread. I still don't do much bread unless toasted as it is bloating.

I do believe I can eat a lot at one time because I need the protein and my body somehow knows. ..so yes I agree with you and do believe the capacity is a good thing.

BTW you are doing great with your progress and are going to do well long term, IMO. You will be amazed at how much things will continue to change for you.

Well this old dude is hitting the sheets so good night.

 

[Marquis Mark]

I think I can eat like I do because he only trimmed off the excess fundus. The rest of my stomach including the somewhat enlarged antrum was left. So there was a lot less to heal and swell. BTW, I eat Vogel Soy and Flax bread (don't know if that's available outside of CA). It's got 6 grams protein, 5 grams fiber and only 13 grams carb/slice. And it tastes good. But, I have to say, nothing I've eaten has really set me off. I think I've been pretty lucky so far.

As for you, the body is an interconnected network. My uneducated guess is that something in your intestines is sending your pylorus the signal that you're starving so that's why it's passing food through so quickly. When you haven't eaten in a while it always goes through quickly. It's only when you're adequately nourished that the stomach puts it in a holding pattern for when it's needed. It's just the body's blender/cupboard, after all. But I would think, in that case, you might get some dumping? Do you ever feel that? Even mildly?

I hope you find some info. I constantly struggle to accept that we are relative pioneers and, as such, are just going to have to live without answers sometimes. Not easy for a control enthusiast (aka control freak) like me.

 

[robs477]

Hey Scott, about how long is food suppose to stay in your stomach? Reason I'm asking is, last night for no reason I threw up (which I hardly ever do), around 3-3 1/2 hours after I had eaten. I had some steak and a small bowl of heavily buttered corn and it was all still there when it came back up. Was easy to tell of course because of the corn. What is the avg time food should stay in your stomach? I think it also has a lot to do with drinking liquids or not with your meal doesn't it? As I thought I read somewhere that water or liquids opens the pylorus almost immediately?? 3-3 1/2 hours seems a bit long to me?

 

[DSRIGGS]

Hey Scott, about how long is food suppose to stay in your stomach? Reason I'm asking is, last night for no reason I threw up (which I hardly ever do), around 3-3 1/2 hours after I had eaten. I had some steak and a small bowl of heavily buttered corn and it was all still there when it came back up. Was easy to tell of course because of the corn. What is the avg time food should stay in your stomach? I think it also has a lot to do with drinking liquids or not with your meal doesn't it? As I thought I read somewhere that water or liquids opens the pylorus almost immediately?? 3-3 1/2 hours seems a bit long to me?

Sorry I just saw this but you believe Cameron's Gi at Northwestern who diagnosed his gastroparesis by doing a four hour gastric emptying study, said that by two hours most emptying should have happened. Most places only do a one hour study and it can miss problems like Cameron's because Cameron started out emptying okay early in after eating in his study, like 20%, but then it basically stopped by cause at four hours hardly nothing else passed through. The one hour test that is the the GES would have said he was emptying fine when he wasnt.

Not trying to worry you because that s could because one time strange deal for you, but if it persists you know to demand a four hour emptying study. Cameron had pain and bad nausea so he knew something was not right and it took this guy to finally identify why and Dr K to fix him..... He is doing very well but n the s regard now. He does still get nauseous at times but that is due to eating or drinking too many carbs at one time and alcohol didn't do him any favors either).

 

[DSRIGGS]

And my understanding is that the viscosity of the food/liquid is the trigger to release contents.. That is when food reduced to more liquid state it is ready to digest..... But as you know the human system doesn't really break down corn... Hence the corn in your poop that people joke about.

To me liquids go right through. I feel like if I take a big drink of liquid that I can feel it go through and I have the urge to pee almost immediately.