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Protein

October 23, 2010 6:33 am

More than 10,000 different proteins make a person what they are. Protein is found throughout the body–in muscle, bone, skin, hair, and virtually every other body part or tissue.

Complete vs. Incomplete Protein

There are 20 amino acids that are the building blocks for all protein. The body can make eleven of them (non essential) and the remaining nine need to be taken in, which come from the diet (essential). Complete protein sources contain all the amino acids needed to build new proteins. Animal protein sources (meat, fish, poultry, milk, cheese, and eggs) are usually complete. Gelatin is the only incomplete animal protein. Soybeans are the only plant protein considered to be a complete protein. [37] Proteins lacking one or more essential amino acids are called incomplete proteins. Beans, grains, nuts, fruits and vegetables tend to be incomplete proteins. Incomplete proteins can be combined (by consuming different protein sources) to make complete protein. It was believed that these foods had to be eaten at the same time in order to be used by the body to build protein. Studies now show that the body can combine complementary proteins that are eaten within the same day. [38] Examples of combining incomplete proteins include: macaroni and cheese; yogurt with granola; peanut butter and toast. A patient needs a daily supply of amino acids to make protein because the body doesn’t store amino acids like it does fats or carbohydrates. If protein is not consumed in the diet, the body will use the only available source – muscle tissue – to get what it needs. Less muscle tissue further contributes to a slowed metabolism, and reduced fat-burning.

Recommended Dietary Allowance (RDA) for Protein

The Institute of Medicine recommends that adults get a minimum of 0.8 grams of protein for every kilogram of body weight per day, for an unstressed body, to keep the body from slowly breaking down its own tissues [39]. That’s about 8 grams of protein for every 20 pounds of body weight. RDA of protein for women ages 19-70 is 46 grams per day. [39] RDA of protein for men ages 19-70 is 56 grams per day. [39] It has been estimated that Duodenal Switch patients’ malabsorption is 40% of their protein intake. As a result, surgeons generally recommend a daily protein intake of 80-120 grams to their post-op patients. [41-43], [51] The additional protein is also required any time the body is stressed above the baseline. This includes any illness, trauma, injury and post surgical state.

Protein Content in Food

Protein Supplements

For most post-operative patients, after DS, it may be nearly impossible to get the required protein in by the means of meals. If patients are not able to get their daily protein requirements through their diet they should use protein supplements. Supplemented protein is bio available and is absorbed extremely quickly. Look for protein supplements that are low in carbohydrates. There are numerous protein supplements available commercially and IT is best to rotate the types of protein used.

Myth or Fact: Can 30 grams of protein be absorbed at a time?

Does a person with an unaltered anatomy only absorb 30 grams of protein at a time? There is some scientific data to support this position. However it requires extrapolation of data. In a study [73] that when two groups of patients were given two different amounts of protein (30 grams and 90 grams), the amount for protein utilization as indirectly measured by muscle production (reflecting the ability to absorb protein and utilize it) did not increase or correlate with the amount of protein taken. The study concluded that it is probably more important to consume small volumes of protein more frequently versus a few meals with large protein content.

Bioavailability of Protein Types

Bioavailability refers to the protein’s ability to be used by the body and it is measured by Biological Value (BV). The higher the BV, the more bioavailable the protein. The BV numbers below demonstrate how easily the body (pre-DS) can absorb these protein types. The last few protein types mentioned on the list would need to be blended to make a complete protein. Whey blended products, BV 100-159 Whey, BV 104 Egg, BV 100 Cow’s milk, BV 91 Egg white, BV 88 Beef, BV 80 Fish, BV 79 Chicken, BV 77 Casein, BV 77 Soy, BV 74 Potato, BV 71 Rice, BV 59 Wheat, BV 54 Beans, BV 49 Peanuts, BV 43 Post DS patients need to keep in mind that they do not absorb protein from food as well as an individual with a un-altered GI anatomy. Pre-digested (hydrolyzed) protein supplements (like whey) are more highly absorbed and help our bodies get the proper nutrients we need. Make sure the protein powder or drink states that it is pre-digested or hydrolyzed, and the best kind of protein would be a whey blend protein. Second best would be a 100% whey protein. Isolates, though good for a quick acting pick-me-up, are not sufficient alone for post-op DS patients on-going maintenance requirements.

Protein Supplement Recommendations

Protein supplement preferences vary person to person. If possible try samples of the supplement before investing in a large container. Also, your tastes before and after surgery may differ, so wait until you are post-op before sampling. When post-op Duodenal Switch patients were asked about their favorite protein shake here are the overwhelming reported top 3 and how the nominators make it. Champion Nutrition Pure Whey Stack Chocolate – Put 1.5 scoops in 4-5 oz. water, shake well, and serve over ice. – Simply mix it with a fork with cold water and add ice. – In a blender mix 1 cup of milk or water, 1 heaping tsp of instant coffee, 2 scoops of protein powder, 4 ice cubes. – Mix it with ice and water, or ice and soy milk in a magic bullet for a shake! – Shake 6-8 oz. water Champion Nutrition Pure Whey Stack Banana Scream – Milk, whole banana, ice = Milk Shake. – Put 1.5 scoops of protein in 6oz Lactaid Milk, blend well in Magic Bullet, and serve over ice. – 2 scoops powder, 2 c. crushed ice, 1 c. half & half – all whizzed up to milkshake consistency in my blender. IDS Multi-Pro Whey Vanilla-Cinnamon – Mix slurry 1 1/2 scoops of protein powder in 4 oz. of cool water and 2 oz. of 1/2 & 1/2. Pour hot coffee into the slurry and stir. – A “glop” of DaVinci sugar free caramel sauce + 8 oz. water + ice, blended. – 1/2 cups half & half, 1/2 cup Oregon Chai Tea (I use slightly sweet but there is also sugar free), 1 scoop IDS Cinnamon Vanilla. Heat half & half with Oregon Chai until luke warm. Stir in powder, heat in 20 seconds intervals until hot. For Vitalady’s Protein Comparison Chart: Protein Comparison Chart

Carbohydrates

October 23, 2010 6:31 am

A sugar molecule is the basic building block of every carbohydrate. The body uses carbohydrates to break it down to glucose (blood sugar), which is the source energy for the cells, tissues and organs of most living things. The glucose can be used immediately or stored in the liver and muscles to be used later, when needed. The most common forms of carbohydrates are sugars, starches and fibers. Starch carbs are found in all cereal grains, as well as roots and tubers. Starchy foods include: bread, pasta, rice, noodles, couscous, tapioca, potatoes, sweet potatoes and yams. Dietary fiber carbs are found in most plant foods, like fruits, vegetables, legumes and whole grain cereals. The digestive system handles all carbs in the same way – by breaking them down into single sugar molecules so they are small enough to absorb into the bloodstream. Fiber is an exception because it can’t be broken down into sugar molecules by the human digestive enzymes and as a result passes through the body undigested. Simple carbs are digested very quickly whereas complex carbs take longer to digest and are usually packed with fiber, vitamins and minerals. There are two types of dietary fibers: soluble (dissolves in water) and insoluble (doesn’t dissolve in water). Soluble fiber binds to fatty substances in the intestines and carries them out as a waste and insoluble fiber helps push food through the intestinal tract, which promotes regularity and helps prevent constipation. Soluble fiber is found in the following: oatmeal, oat bran, nuts and seeds, most fruits (e.g., strawberries, blueberries, pears, and apples), dry beans and peas. Insoluble fiber is found in the following: whole wheat bread, barley, brown rice, couscous, bulgur or whole grain cereals, wheat bran, seeds, most vegetables, and fruits. Digestible or Net Carbs It is common to see the phrase “Digestible Carbs” or “Net Carbs”. This refers to the total amount of carbs in a particular food that can be absorbed and digested in the intestinal tract, which excludes dietary fiber, as they cannot be digested. Sugar alcohols are carbs that we do not completely absorb. The most common ones are sorbitol, xylitol, mannitol, and maltitol. These sugar alcohols can cause increased bloating, gas and diarrhea since the unabsorbed components end up fermenting in the intestine. Sugar alcohol has also been advocated as a low calorie sweet substitute. One unique beneficial side effect of the Xylitol is it inhibits bacterial growth in the mouth, and reduces the chance of tooth decays. The easiest way to calculate the net carbs in a food is to subtract the dietary fiber and sugar alcohol content from the total carb content. Example: Total Carbs: 30g Dietary Fiber: 5g Sugars: 1g Sugar Alcohol: 15g Net Carbs: 10g (30 – 5 – 15 = 10) Also, remember that in general not to eat carbs before bedtime as it triggers insulin and this initiates fat storage, which is probably counterproductive when it comes to weight loss.

A DS Carb Primer

By Kelly L. All carbohydrates (carbs) begin digesting in the mouth when it comes in contact with the enzyme amylase. Even complex carbs begin the process of breaking down into simpler types at this point. Since monosaccharides need no further digestion to be absorbed, the body begins absorbing, a very small percentage of the total, them as soon as they hit the mouth. Enzyme activity continues in the stomach but it is slowed by the contact with stomach acids. When carbs enter the small intestines this is where DS may assist in preventing some absorption of the more difficult to digest polysaccharides (starches). This reduced absorptive capacity is because of the separation of the secreted enzymes by the pancreas and the liver, from the food that is being delivered for breakdown. A type of enzyme, amylase, is secreted by the pancreas into the duodenum that cuts carbs down into simple sugars. As it passes further, more enzymes break the carbs down into even smaller bits until they are eventually converted to glucose and absorbed by the mucosa lining, villi, of the small intestinal walls. Because of the switch portion of the DS, the amount of time that a polysaccharide is in contact with pancreatic enzymes is reduced. This is probably why many people have gastrointestinal issues when eating starches. Also, glucose is absorbed by the villi in the intestine, so those with shorter common channels and those earlier out will also absorb less. As the body adjusts to the DS, a patients villi becomes thicker and more efficient to counteract the malabsorption; this may be a component of some weight regain years after DS.

Carbs and Gas

By Diana C. Fruits comprise simple carbs (primarily fructose, which is a monosaccharide and doesn’t have to be digested at all) so they are fully absorbed in the small intestine, and fiber, which is indigestible by both our guts and our bacterial symbionts. Flour products contain starches, which are made up of long chains of monosaccharides — thus, polysaccharides — which are only partially digestible by our rearranged guts with the diminished contact with digestive enzymes. This results in some of the starch ending up in the colon where it is digested by our bacterial symbionts to produce gas. The more whole grain-y the complex carbs we put in our guts, the higher the fiber (indigestible) to starch ratio, and the less likely to cause issues. Other things that cause gas are specific starches that are indigestible in our guts, which our colon bacteria are happy to process, such as raffinose, inulin (the offensive starches in beans, broccoli, etc.) and retrograded starch, which is caused by cooking then cooling of amylose. The primary starch in white flour products, which produces a form of amylose is indigestible in our small intestine, but can be digested by our colon bacteria. This of course is a worse problem for DS patients who digest starches even less than others. For more information on gas and flatulence-producing foods: Natural Gas: Myths and Facts

More Information on Carbohydrates

Artificial Sweeteners and Cancer: Questions and Answers

Weight Loss

October 23, 2010 6:27 am

Weight loss after surgery can be very dramatic. The fastest rate of weight loss will happen during the first 3 months after surgery. After the Duodenal Switch patients can expect to lose 0.5 to 1 lb. per day or 40 to 90 lbs. by 3 months post-op. [51] Rapid weight loss decreases by 6 to 9 months after the procedure and peak weight loss is achieved at 12 to 18 months post-op. For some, getting rid of weight daily becomes an obsession after surgery. The weight may fluctuate up or down on a daily basis. Moreover, the weight loss may not be constant and regular. Do not be alarmed with the small weight gains or lack of weight loss over a short period of time. The best advice is to get weighed 1-2 times a month at the follow-up with a doctor. If a patient is a member of any surgery support forums they will probably be comparing their weight loss with others. IT is important not to compare weight loss rates among other patients. There are a wide number of variables that may not be known, all of which are factors specific to a patients weight loss rate. As we said above, in the first 3 months a patient can lose anywhere between 40 to 90 lbs. That is a very big range..

It’s not POUNDS, it’s PERCENTAGES!

By Carolyn M. Two people, both 6 months post-op. One has lost only 63 pounds and feels bad about her “slow” weight loss. The other has lost 96 pounds and thinks she’s doing great. They are both wrong. Person A had only 105 excess pounds, so she has already lost 60% of her excess weight. She is actually ahead of the game at 6 months out and is on track to lose it ALL. Person B had 265 excess pounds. At 6 months out she has only lost 36% of her excess weight. At this rate, she will end up retaining 28% of her excess weight, enough to keep her in the obese category. What this means is that the percent excess weight loss is a much more critical number than that absolute number of pounds lost. Percent of excess weight lost: pounds lost divided by total excess pounds. Use a BMI of 30 as a goal weight. Please note: These are averages. A patient’s individual weight loss will be different.

Weight Loss Goals for the Super Morbidly Obese

By Amanda L. – DS Pediatric Endocrinologist For some of the super morbidly obese (BMI 50+) the goal of 100% of estimated weight loss cannot be achieved without the plastic-reconstructive surgery. My plastic surgeon prefers people to be at 90% of estimated loss before extensive lower bodywork. Not only that but she required you to be at a stable weight for 6-9 months.

Valerie G.

October 23, 2010 3:49 am

Valerie’s Stats

DS Veteran: Valerie G.
Location: OH, USA
Surgery Date: Oct 31, 2005
Surgeon: Rita Anderson, MD
Highest Weight: 286 lbs
Pre op BMI: 44
Pre op Weight: 272 lbs
Goal Weight: 150 lbs
Current BMI: 25
Current Weight: 148 lbs

Valerie’s Message

How many ways can I say that I love my DS? Once I got over the initial recovery period, losing my weight and keeping it off is easier than I ever imagined, thanks to my DS.

My weight history started with my mom doing fad diets with me starting with my first ‘puberty pudge’. This continued with us finding new and creative ways to starve ourselves, while I rarely lost anything despite my best efforts. I was an athlete in high school despite my obesity, and continued to be obese despite my level of activity. I felt very hopeless, and continued to gain weight into adulthood, stopping only when I went back to starving myself again. It was an extremely uncomfortable rollercoaster ride that was my final straw. Add to that my extreme foot pain and chronic back pain, and I wasn’t living my life to the fullest. From that day, I started researching wls. It was through my research that I discovered the duodenal switch, and it just made SO much sense for me. The malabsorption is just what my “hold on to each and every calorie” body needed.

Today I’m a whole new woman. My career is reaching new heights, thanks to my confidence and I hate to say it, but my appearance too. Being a corporate trainer, appearances do matter. I feel that today my appearance finally matches my personality. I was able to confirm that one day when I met a gentleman face to face after training him over the Web several times galarson.com. His first statement to me was “you look just as I pictured you to be”. To me, I knew that day that I made it! Today my foot and back pain are gone, too. I’ve never been healthier, and I owe it all to the DS!

Articles by Valerie G.

Famous Recipes
What to Expect Following Surgery

Lisa P.

October 23, 2010 3:47 am

Lisa’s Stats

DS Veteran: Lisa P.
Location: ON, Canada
Surgery Date: Oct 7, 2008
Surgeon: Marek Lutrzykowski, MD
Highest Weight: 340 lbs
Pre-op BMI: 58
Pre-op Weight: 340 lbs
Goal Weight: 150 lbs
Current BMI: 29
Current Weight: 175 lbs

Lisa’s Message

Having the DS was the single greatest thing that I ever did for myself. I have more energy now than I have in at least 15 years. I look better, I feel better and I don’t feel like I have to hide in my house anymore. I am out enjoying life now. I know this has been said a million times, but the only regret I have is that I didn’t have this sooner, premium home cleaning services. I missed out on so much while my kids were growing up, and I’m trying to make up for lost time now. I am very close to my personal goal, and I’ve gained an inch in height! I thank my lucky stars every day that I was able to have this surgery.

Heather M.

October 23, 2010 3:44 am

Heather’s Stats

DS Veteran: Heather M.
Location: ON, Canada
Surgery Date: Dec 5, 2007
Surgeon: Marek Lutrzykowski, MD
Highest Weight: 313 lbs
Pre-op BMI: 49.6
Pre-op Weight: 269 lbs
Goal Weight: 150 lbs
Current BMI: 20.9
Current Weight: 133 lbs

Hayley F.

October 23, 2010 3:42 am

Hayley’s Stats

DS Veteran: Hayley F.
Location: TX, USA
Surgery Date: Mar 5, 2007
Surgeon: Daryl A. Stewart, MD
Highest Weight: 346 lbs
Pre-op BMI: 48
Pre-op Weight: 346 lbs
Goal Weight: 177 lbs (BMI of 24.9)
Current BMI: 20.1
Current Weight: 144 lbs

Hayley’s Message

I started this journey weighing 346 lbs, wearing a size 24 pant, and 26/28 top. My goals were to get to a size 8 jean (I was determined to get there, even if it was only for a short visit) and to weigh 170 lbs by one year. I surpassed all of these goals!

Progress Report:
(1 week): -30 lbs total
(3 weeks): -40 lbs total
(1 month): -44 lbs total -44 for month
(2 months): -64 lbs total -20 for month
(3 months): -78 lbs total -14 for month
(4 months): -91 lbs total -13 for month
(5 months): -101 lbs total -10 for month
(6 months): -115 lbs total -14 for month
(7 months): -126 lbs total -11 for month
(8 months): -136 lbs total -10 for month
(9 months): -146 lbs total -10 for month
(10 months): -153 lbs total – 7 for month
(11 months): -162 lbs total -9 for month
(12 months): -170 lbs total -8 for month
(13 months): -174 lbs total -4 for month
(14 months): -181 lbs total -7 for month
(15 months): -188 lbs total -7 for month
(16 months): -192 lbs total -4 for month
(17 months): -192 lbs total -0 for month
(18 months): -196 lbs total -4 for month
(19 months): -199 lbs total -3 for month
(20 months): -199 lbs total -0 for month
(21 months): -200 lbs total -1 for month
(22 months): -202 lbs total -2 for month

As I lost weight, I changed my goal weights. I wanted the following:

Normal BMI (must weigh 177 lbs)
Weigh 170 lbs (personal goal 1)
Weigh 160 lbs (personal goal 2)
Weigh 146 lbs (personal goal 3) so I could say that I lost –200 lbs

I reached all my goals. I now weigh 146 lbs, I wear a size 2 jean and Small/Med tops. So I have lost 202 lbs, I dropped 6 shirt sizes, and 11 pant sizes.

I can sit anywhere I want w/out thinking twice about the seating (restaurants, theatres, roller-coasters, planes). I can double cross my legs. I can put my feet up in the theatre seat. I can shop at any store. I can pick an article of clothing off the rack and KNOW it will fit without having to try it on. I’m wearing skirts, shorts, and dresses (I never wore those as a MO person). I’m wearing sleeveless tops for the first time in my adult life. All the discoloration on my skin from being over weight has vanished. I can walk and walk and walk and not get out of breathe or cramp up. I have energy! I am no longer the biggest person in my family. I am the smallest/lightest person in my family now.

I have had no complications or bad side effects. I do not suffer from any bathroom issues and I have no problem maintaining my weight. I lost my weight without ever going on a diet. The DS is a dream come true! For more information about me, check out my profile on ObesityHelp.

Articles by Hayley F.

Acne

Elizabeth N.

October 23, 2010 3:39 am

Elizabeth’s Stats

DS Veteran: Elizabeth N.
Location: NJ, USA
Surgery Date: Dec 4, 2006
Surgeon: William S. Peters, MD
Pre-op BMI: 63
Pre-op Weight: 400 lbs
Current BMI: 25.8
Current Weight: 170 lbs

Articles by Elizabeth N.

Post Surgery Advise

Diana C.

October 23, 2010 3:31 am

Diana’s Stats

DS Veteran: Diana C.
Location: CA, USA
Surgery Date: Aug 5, 2003
Surgeon: Robert Rabkin, MD
Highest Weight: 293 lbs
Pre-op BMI: 49
Pre-op Weight: 285 lbs
Goal Weight: 160 (after plastics)
Current BMI: 29
Current Weight: 175 lbs

Diana’s Message

Was a solid child, and then became obese at age 16 when my mother took me to a “health food doctor” who ordered me to stop taking my thyroid meds cold turkey. I gained 30 lbs in one month. Yo-yoed up and down, mostly staying around 210-220, for the next 34 years. Occasionally got down to the 170s-180s via starvation diets and diet pills, but couldn’t stay there. Had two babies, with fortunately uncomplicated pregnancies.

Married my second husband at age 45, and over the next 5 years went from 235 to 290+. I enrolled in a Phase III clinical trial for an obesity drug, which didn’t work, and then gave up. I started looking into WLS in late 2002.

I found ObesityHelp.com, and the more I read, the more appalled and depressed I got. I knew there was no way in hell I could live the way the RNY and LapBand required. I was about to give up entirely, when someone read a post I wrote bemoaning my dilemma, and led me by the virtual hand to information about the duodenal switch.

Well holy crap–this made sense! I have a PhD in biochemistry and molecular biology from UCLA Medical School, so I know enough about science and medicine to understand how the DS differs from the other surgeries. I couldn’t believe I hadn’t seen anything about it before, despite 4+ months of research! As soon as I understood how the DS works, I was sold–and thus began my six month quest to get insurance approval.

Long story short, I had a ferocious battle with Aetna, and ultimately won, after threatening to sue them. I had to pay several thousand dollars of my surgeon’s fee, but my hospitalization was fully covered.

I had an uncomplicated surgery with Dr. Rabkin 12 days before my 50th birthday. While I did not have severe co-morbidities prior to my DS, there certainly were several in my future, as evidenced by my SMO mother’s health–I had pre-diabetic hypoglycemia; my cholesterol was about to cross over into the too-high range, as was my triglyceride level; my C-reactive protein, which is an indicator of cardiovascular risk, especially in women, was sky-high, and my white blood count was chronically elevated, both indicators of inflammation of the blood vessels–that earned me a statin prescription and my very own cardiologist; I had urinary stress incontinence; shortness of breath on exertion; my feet KILLED me after walking more than 10 minutes; sex was–well, you can guess.

8 months after my DS, my company closed its offices in CA, and I had to look for another job. I can’t express what a difference it made to be able to go on job interviews and look decent in a suit. One year after my DS, I went hiking and camping with my family and friends–something I would NOT have been able to do pre-op. A month later, my daughter and I traveled in Europe for nearly 3 weeks at a fast pace, climbing towers in every town we went to, including to the top of the Vatican dome in late August.

I would be remiss if I didn’t confess that I did NOT limit carbs enough during my “honeymoon” period. I lost to 205 lbs in one year, and then stopped dead. I had NO trouble maintaining that weight, but I was stuck there for well over 2 years. I wasn’t unhappy with this–I was in size 14-16 at that weight, in the NORMAL stores. Then, seemingly for no reason at all, in Nov 2006, I started slowly losing weight again. I have lost 30 lbs in the last two years, and started exercising, which has put me in size 8-10 (even at 175 lbs!), and hope to win my current battle against insurance stupidity in order to get my reconstructive surgery, which should put me at my goal weight of 160 lbs. 5 years out, and I am not only NOT fighting regain (and not dieting in the least), but I am still slowly losing. This does not suck.

I feel VERY strongly that the DS is by far and away the BEST bariatric surgery available today, both in how well it works, and in the quality of life it provides. Having said that, it is not for everyone. If you cannot commit to eating 80-100 g of protein a day, every day, for the rest of your life, go find yourself a diet with a scar, or a diet with a choke chain–the DS is not for you. If you cannot commit to a strict regimen of vitamin, mineral and probiotic supplementation, don’t bother. If you cannot commit to having blood drawn at least yearly, more often if necessary, and making appropriate changes in your diet and/or supplements, go get something “less drastic”–a surgery that won’t work as well, but won’t be as likely to kill you if you can’t be compliant. If you can’t commit to being proactive about your health, for the rest of your life, including standing up to doctors who want to blame everything that is wrong with you on the DS (just like they used to blame everything that was wrong with you pre-op on your obesity), this fantastic surgery is not for you. Frankly, if you are too stupid or passive to be a proactive and informed patient, move along and have a less successful but less “dangerous” surgery–it probably won’t work very well for you, but at least you won’t become a statistic that makes the DS look bad. We don’t want you to do that, trust me.

Carolyn M.

October 23, 2010 3:30 am

Carolyn’s Stats

DS Veteran: Carolyn M.
Location: TN, USA
Surgery Date: Nov 3, 2003
Surgeon: Dennis Smith, MD
Highest Weight: 323 lbs
Pre-op BMI: 52
Pre-op Weight: 317 lbs
Goal Weight: 155 lbs
Current BMI: 26
Current Weight: 155 lbs

Articles by Carolyn M.

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