I like listening to Dr John Pilsher. He seems levelheaded and up to date on current medical issues concerning WLS. Some of his videos seem to buck the system about things we thought to be true. Malabsorption with bypass for example is a myth according to him. What say you???

everything I've heard is that malabsorption of calories (in bypass) is temporary - lasts a year or two at best. Malabsorption of vitamins, however, is permanent, which is why we have to take supplements (in duodenal switch, the calorie malabsorption is also permanent - which is why it's a stronger surgery). I didn't listen to this whole video, but I think this is essentially what he is saying (I just listened to a couple more minutes of it - he did say we need supplements of some things like calcium and iron, because we don't absorb those well - I'll listen to the rest later to see if he mentions other vitamins - but i'm on my way out the door at the moment...). But that whole thing about carbsi in the intestines and diarrhea - that refers more to DS patients since that is truly a malabsortive surgery - and the malabsorption (of calories and everything else) with the DS is permanent.

Edited June 4, 20233 yr by catwoman7

3 hours ago, catwoman7 said:

everything I've heard is that malabsorption of calories (in bypass) is temporary - lasts a year or two at best.

I watched it again to see if I missed something. He does mention a 6 -18 month period of greater weight loss with bypass but attributes it to the stomach healing, less food. Not to malabsorption. He also claims this myth originated as a marketing ploy to promote the Gastric band. Hmmmm. And now... the sleeve?

If science proves what he is saying and doctors are using misinformation to steer us towards an easier procedure or one that might need a second surgery, then so be it I guess. For me it's good news because the last thing I need is to come out the other side of my RNY frail and malnourished

there's probably some things that aren't well understood about weight loss surgeries in general, so he/you may be right. It is different from what I've heard elsewhere, though. Eight years out, and I'm definitely not malnourished! (although there are times I do miss the months when I was at my lowest weight - which was admittedly too low for me....but it was a kick being told I needed to gain a few lbs (for the first time in my life..))

Yeah I tend to be a sceptic sometimes. I remember asking my surgeon that if the bypass is considered malabsorptive, how will I be assured my vitamins will be enough. He just smiled and said not to worry, just take them. Of the 4 doctors in that office he's the only one that does the RNYs. All the rest do the sleeve. I guess it's the popular choice nowadays.

1 hour ago, catwoman7 said:

it was a kick being told I needed to gain a few lbs (for the first time in my life..))

I'm looking forward to that day myself. And I've seen your pics. You look fantastic!

Nothing wrong with being a skeptic or wanting to dig for further information before making a final decision or taking a position. Maybe some of the malabsorption conflicting information could be attributed to simply how your body may react to the surgery. It’s not expected to occur but might in rare cases. Same could be said of any surgery. For example it’s very unusual for people to develop a protein malabsorption issue after a gall removal surgery but here I am.

Keep track of your vitamin needs with blood tests. Then you can make informed decisions about what vitamins you do or don’t need & how much you need to take. And don’t be surprised by variations in your levels & therefore changing needs.

I think sleeve is popular as it’s the less invasive in regards to changes to how the body works of the surgeries and can be converted to a stronger surgery if needed. Same with the band back in the day. That was my thinking anyway.

Edited June 5, 20233 yr by Arabesque

1 hour ago, BabySpoons said:

Yeah I tend to be a sceptic sometimes. I remember asking my surgeon that if the bypass is considered malabsorptive, how will I be assured my Vitamins will be enough. He just smiled and said not to worry, just take them. Of the 4 doctors in that office he's the only one that does the RNYs. All the rest do the sleeve. I guess it's the popular choice nowadays.

yes - it's definitely the most popular choice nowadays. I think most of the people who opt for bypass now are people with GERD issues. And a lot of younger surgeons probably don't have as much experience with RNY because most of what they do is sleeve (because it's the most common surgery now) - so they're probably more likely to recommend it, too.. The surgeon I had is probably 60 years old now and has done A LOT of RNY's, since that was considered the "gold standard" for many years - but they have some newer ones in the clinic now. Not sure if the newbies there are doing much in the way of RNY or not - but I wouldn't be surprised if they're not.

1 hour ago, BabySpoons said:

I'm looking forward to that day myself. And I've seen your pics. You look fantastic!

thanks! I'd like to lose about 10 lbs, though. I did need to gain some weight, but these last 10 lbs I could do without. My doctor says to quit worrying about it because I look fine, but it's a mental thing with me, I think. I liked seeing those low numbers!!

21 minutes ago, Arabesque said:

Same with the band back in the day. That was my thinking anyway.

Band was less invasive for sure, but they don't call it the "crap band" for nothing! Everyone I know who had one has had it removed. A lot of surgeons were still doing bands when I started looking into surgery (c. 12 years ago - but finally had it eight years ago). I'm REALLY, REALLY glad I didn't choose that. You'd be hard pressed to find anyone placing bands now...

Oh yes. I’m always surprised by how often people still say they’re getting a gastric band & that they’re still offered as an option. It takes very little reading to discover all the issues with them. I remember when I was researching options pre surgery I was quite astounded by the problems & so very quickly ruled it out. No way!

12 hours ago, catwoman7 said:

I think most of the people who opt for bypass now are people with GERD issues.

That was me. Fixing that alone was worth getting the bypass. I didn't need to exasperate it further by getting a sleeve.

But another major reason I opted for bypass was hearing that some sleeve patients were only seeing a 30–40-pound weight loss. I struggled to lose that much anyway with diet and exercise and wasn't willing to go through major surgery to find out I was in that category.

My GP confirmed this to me when I went to her for a release signature. She asked which procedure I wanted. I told her bypass. She said good because she has a close friend who had the sleeve and helped her through all of the process. Said she did everything right (that she knows of) and could only lose 30 pounds. Now after all that she's taking Ozempic injections.

I told her I don't have the time or money to try one first to see if it works. So yeah...I went for the "gold standard."

12 hours ago, catwoman7 said:

And a lot of younger surgeons probably don't have as much experience with RNY

Probably so but mine is pretty young. 30's maybe. And oh so handsome. LOL I went to him specifically because his office was the only one approved by my insurance as in network in the state. He's smart and funny too. When I asked him if I had stiches or staples, he said titanium. You will have them forever and no you won't set off metal detectors at the airport. xD

Here's the video that helped me to decide between the gastric bypass and the sleeve. It's lengthy but informative and hopefully helps anyone trying to decide which procedure to get. Make sure to consult with your primary care physician as well. I chose what I felt was best for me. YMMV

My mom had bypass and has struggled with malabsorption ever since. Mainly vitamin D, B12 and Iron. I think there is a lot to learn about these surgeries because everyone is so different.

4 hours ago, mcipanda said:

I think there is a lot to learn about these surgeries

Agree... I will be getting tested at my 3-month follow-up for vitamin levels. Fingers crossed.

i opted for sleeve cuz:

(1) i wanted to continue taking a prescribed NSAIDs with no interruption

(2) i was wary of dumping syndrome

and

(3) the thought of "re-routing my plumbing" gave me pause

well.

1- Turns out i no longer needed my NDAIDs soon after surgery, so that was moot.

2 - I got dumping syndrome anyway, yay.

3 - the fear of re-routing my plumbing was probably just silly cuz i couldn't feel anything anyway.

Further i developed an issue with reflux (nothing unmanageable, but still).

But in the end, im still ridiculously pleased with my decision, and i lost 120 lbs in 7.5 months (i know/read lots of accounts with the same-ish loss numbers, and am actually surprised that a 30-40 lbs loss on sleeve is common!)

would i make a different choice knowing what i know now? who knows. i have no idea what it would have been like if i had by-pass since i didn't do it. and the results of my sleeve went a-ok for me, so i figure i won't sweat it.