Weight regain is the norm after any weight loss surgery. This is also true with the Duodenal Switch, however, to a much less degree and significance.
There are a number of possible explanations for this.
A. Regression to poor dietary choices, and reduces physical activity.
a. As patients get further away from their surgery, the normalcy returns to their lives. This may include: return to an old habit of fast food, unhealthy choices, decreased activity, and indiscretion with alcohol, carbonated drinks, and artificial sweeteners. Note that each and every one of those mentioned above may not be what results in the weigh gain but rather the collective synergistic effect.
b. When a patient is experiencing weight gain, the most important step is to look at the changes that had occurred over time with regards to the food intake and the activity level. A food diary should also be very specific of listing “everything that touches the lip and gets in my mouth” and not just listing food items. It may not be as obvious what a patient is consuming unless all the ingredients are listed.
B. Anatomical Changes Over Time
a. Stomach- stretches accommodating more volume over time.
b. Small Bowel- the mucosa of the common and the alimentary channels get more efficient, thicker, and deeper then are able to absorb more, even though the length of the bowel is unchanged.
a. Our Basal Metabolic Rate (BMR) drops significantly as we age. This means that even if no changes are made to our diet, activity level, stomach size and the efficiency of the small bowel, we will gain weight as we age. This is because our body is with lower BMR and unchanged energy absorption will have energy excess.
Duodenal Switch has the benefit of malabsorption to aid in keeping the excess weight off, but it is not a fail-safe procedure. To follow are a few stories of weight regain following Duodenal Switch, how it happened and what the patients did about it.
This is my story about weight regain after Duodenal Switch. I had my DS eight years ago. At the time, not as much information about the DS post-op life was available, as there is today. It wasn't uncommon to hear people say that they can eat everything they want without consequences. That may be true for some, but not all. The DS isn't a free ride for everyone and weight regain is possible. This is my story of how I regained weight and what I've done about it.
I started at 406 lbs. At the time I had my DS, there weren't many surgeons performing it, so I had to travel out of state to get it done. The instruction I was given after surgery was simple, eat at least 80 grams of protein a day and make sure to eat it first. Anything else afterward that fits in your stomach is ok. The assumption being that after protein, you wouldn't have much room for other foods.
I became very active once I started to lose weight. I always enjoyed being active when I was younger so I started to run and lift weights five times a week. I think that really helped with my weight loss. At my lowest I was around 240lbs., which might seem high, but I actually looked really good at that weight. I am 5'10 and have very dense bones along with a lot of muscle mass - from working out.
A few years later I had some plastic surgery procedures and loss a lot of blood making me anemic. It took six months of trial and error then going to a hematologist before I got a series of iron infusions. During these six months, I got very tired. I stopped working out and was so out of it that I would fall asleep at my desk. I basically worked and slept, that was it. I eventually had a weight regain of 20 lbs. I should have contacted my surgeon's office or asked for advice on the DS board, but I didn't. That probably would have resulted in getting the iron infusions a lot quicker. Lesson learned!
At another point during the last eight years, I developed a bad case of IBS due to some external stresses in my life. I was in a lot of pain and discomfort all the time. I went to a specialist and had a colonoscopy and was told that it was IBS then I was given a diet to follow that would stop irritating my digestive system. I was so miserable that I would have done anything to feel better. So, I followed the diet that was very anti-protein and pro-carbs. If you google recommended diets for IBS, you will see what I mean. I gained back more weight from the diet and from lack of exercise due to being in pain. Once I eliminated the external stresses and followed the diet for a while, I eventually got better and the IBS went away completely. I think the fact that I entered into therapy helped a great deal as well.
Last winter, I suffered a fall down some concrete steps. I slipped on some ice I didn't see and landed at the bottom step on my arm and shoulder. I ended up shattering my right from the shoulder almost to my elbow and was immobilized for three months, then in intensive physical therapy for six months. During this time, I couldn't do anything for myself. I sat at home; my friends and family brought me food and goodies, which I ate. I also gained more weight.
So, over the course of 8 years and the three incidents I mentioned above, I had a weight regain of 50 lbs. I got way off track from how I should be eating and was just really disconnected from my body and all things DS. I knew I needed to make some changes to turn things around.
I got back on the Obesity Help DS Forum and started asking questions. I found out how well informed everyone is about the DS now and got myself back on track.
I started by tracking my daily food intake in fitday.com. Boy, was that eye opening! I realized and saw for myself just how upside down my protein and carb intake were. I didn't change my eating habits right away, I kept tracking in fitday.com and started to read the daily food & fitness threads on the DS Forum to get an idea of how others were eating as well as getting food suggestions. After a couple of weeks, I started to cut way back on the carbs and add more protein into my daily diet. I started this process mid May 2008 and by June, I had made major shifts in how I was eating.
I should also mention that I had been exercising regularly all along when I could. I started with solitary exercises like running on a treadmill and lifting weights. Later, I found a Pilates instructor and started taking equipment and mat classes. Pilates is something that I've come to love and started doing 4-5 times a week. I then added Zumba into the mix and got to the point where I was working out 8-9 hours per week and loving every minute of it. I think finding something that you love and something that doesn't feel like work is the key. I've enjoyed getting more in tune with my body and spending time with the women in my classes.
The result of the changes to my eating habits and the increased exercise has helped me lose all the weight I regained plus a few more, 55 lbs. in total. I am back in my skinny jeans and having to buy new clothes. I indulge occasionally and find that as long as I don't indulge more often than I do, I am ok. Moderation is key. I still enjoy chocolate and goodies when craving them, but they aren't daily staples anymore.
In the course of the past six to seven months, I have got back to the basics with my eating, but I don't feel deprived. I've increased my exercise, which I enjoy and have exceeded my original goal. Life is good!! The DS is fantastic!! It's still working for me after all these years!
Here are the DS basics as prescribed to me by the members of the DS Forum and what I've been following:
- I eat 80-100 grams of protein per day
- I keep carbs at 50 grams or less per day
- I try to keep the carbs I do eat complex and only rarely eat simple carbs
- I drink at least 64 oz. of water or SF liquids every day
- I don't worry about fat or number of calories
- I track my food on fitday.com every day
I hope this can be of help to you and thank you for reading my story!
I'm 6 ft. tall and was 377 lbs. on the day of surgery. I was 50 years old and didn't really set a specific goal, but being below 200 lbs. would have been nice. I lost 130 lbs. in the first year and a half, and if I stopped right there, I would have been happy. Not skinny, by any means, but I just wanted to feel lively and be active again which I did.
At about 2.5 years out, I stopped focusing on protein and had a pretty steady diet of carbs and sweets. Cruelly, I never focused on sweets before the DS, but for some strange reason, I developed an unbelievable sweet tooth post op; I was always a salty/crunchy kind of person. Many post-op DS patients find it difficult to eat too many sweets, but not me. I never feel full when I'm eating sugary treats.
I used to weigh myself daily, which helped me stay on track (that doesn't work for everyone, but it's a necessity for me). I totally lost control and gained 70 pounds in the next year. I hit 311 lbs. earlier this year. I've always been good about my vitamins and water, so my blood work has been fine. I have avoided beating myself up and also avoided considering myself a total failure at the DS. I simply fell back into old habits of letting my weight put up a wall to protect me from things I wanted to avoid in day to day life.
Earlier this year, after addressing a few non-DS and non weight related health issues, I realized that I want to feel good again, just like I did a few years ago.
I started around April of this year and here is how I got back on track:
1. I cut my carbs back to below 50.
2. I weigh myself daily. Beware, if you can't be okay with daily fluctuations, this may not be a good thing for you to do.
3. For a few months, I tracked my food on the Daily Plate. Once I got back on track, I stopped the daily record, but will return to it if I feel out of control. Getting in over 100 grams of protein is easy for me; it's keeping the carbs low that was more difficult.
4. I've cut out all major sugar for now. I'm sure I'll be able to re-introduce sugary treats back into my lifestyle someday, but just not now.
5. I've continued to see a counselor because food has always been my coping and self-comforting mechanism, which I have to work on that daily.
6. I also refocused on how blessed I have been that I was able to have the DS after canceling my appt. for an RNY when I heard about this option. My insurance approved me in a matter of days. I also had incredible friends who traveled for 2 hours, took time off work to take turns and come and stay with me at a hotel for one week after I was released from the hospital. (I had my surgery in Dayton, but live in Columbus).
Bottom line, I've now re-lost 38 of the regained 70 lbs. I am back on track and feeling great. I've started walking again, which I still hate doing, but I'm doing it.
The DS continues to work. I may not be losing as fast as 4 years ago, but it's still coming off faster than a non-WLS person. Yes, you can regain some weight on the DS if you stop eating protein first and slip back to poor dietary choices that will cause weight gain in everyone.
I love not having to worry about fat. I do love DS and I'm thankful it continues to work, even 4 years later! As I said at the beginning, I'd do it all again in a heartbeat.