There is widespread information on the web indicating that the gastric bypass reduces food absorption. Dr. Pilcher explains where this idea came from, and how we know it's not correct.
I had my GB RNY 20 years ago! I’ve never had bowel issues, but I always believed I had reduced absorption of macronutrients/ nutrients! Thank you for shedding light on this confusing topic.
Dr. Pilcher, my surgeon feels that the sleeve is superior for having less needs of regulating psychiatric medicine after surgery, it seems that you are of the opinion that the bypass and sleeve are comparable. Can you speak to the regulatory needs of psychiatric medicine after surgery in both cases?
It's true that many physicians perceive there is malabsorption of medicines in the setting of gastric bypass, but honestly, I have not seen a need to modify psychiatric medicines with the exception of lithium, which absorbs better after gastric bypass.
Hi doc. Having surgery in 3 weeks! 😊 I’m scheduled for bypass but I think I’m going to switch back to the sleeve. Is there a way to not have heartburn if you get a gastric sleeve? Should the doctor cut away 60% of the stomach to reduce the amount of pressure on the remaining stomach? Also, I’ve been more serious now with my healthy eating and exercise! I started intermittent fasting again & lost 8 pounds in a week! Along with keeping a low carb diet and exercising daily. My BMI is 30 and I have iron-deficiency anemia. I’m only doing this because my A1C went up to 9 and I’ve been battling Type II Diabetes for 10 years now. Do you think I should do any weight loss surgery now or postpone it & keep trying to lose weight? My hematologist said if I did bypass I’d have to get iron transfusions every week for the rest of my life! So that’s why I wanted to switch back to the sleeve. I really need your opinion please. Thanks!
I’ve noticed very fatty stool and very foul gas with my GB. I’be heard the same from lots in the community. Does this go away? Is this more rare then I assumed?
The fatty stool and foul gas might be related to the way your gastric bypass was done, because some non-standard variations on the gastric bypass do intentionally create malabsorption. This would be a good question to ask your bariatric surgeon. If you have had a standard gastric bypass, then it's quite likely the problem can be corrected by modifying your food plan or possibly with probiotics. There are several potential factors at play, so again this is a very good topic for your bariatric team. Best of luck!
@@DoctorJPI’ve been told by terry simpson that probiotics bacteria don’t make it through your stomach acid and survive should we still use probiotics or are they just a waste of money
Glad it was helpful! To be clear, there are way ways of doing the gastric bypass that can create malabsorption, but that's not the "standard" gastric bypass. Best of luck on your journey!
Doctor, how is it NOT Malabsorptive if food doesn't pass through at least one third of the length of intestines? Also is it a must to have vitamins for lifetime period after the surgery?
Thanks for your question Amine. The standard gastric bypass is not malabsorptive for macronutrients (protein/fat/carbs) for 2 reasons: 1) the operation does not bypass 1/3 of the intestine, though it's hard to be exact because human intestinal length varies tremendously 2) even though #1 is true, given the high quality food available to humans today it is not necessary to use the full GI tract for absorption We can observe that the standard gastric bypass has normal absorption by feeding standard meals to non-surgical volunteers and to gastric bypass patients, then comparing the composition of what comes out the bottom end. The results show there are no extra nutrients expelled by the gastric bypass patients. On the other hand, the standard gastric bypass does reduce absorption of Iron, B12, and maybe a number of other vitamins. For this reason we do recommend lifetime daily vitamins.
I have noticed that a not insignificant number of gastric bypass patients do report foul gas. Why might this be, and is it typically a transient problem post surgery? I'm pre-op and quite concerned about this. Thank you!
Thanks for your question Jamie. My impression from talking to patients is that the problem of foul gas most often comes from eating carbs or sugars. The intestine "rejects" the osmotic load and rushes the stuff downstream to the colon where it arrives in a less-digested-than-normal state. Fed by the abnormal levels of fuel, the colon bacteria overgrow and become imbalanced; this is what seems to cause the foul gas. Also check my video on dumping syndrome here ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-D3dd_3suFrA.html
A great question. Revision from Sleeve to Gastric bypass is common enough that I made a video on it: ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-jh_Rr9qLjHM.htmlsi=JjeNrwhb8EUd9del
That's a great question, and it was actually tried in the early days of gastric bypass. You would think that it would add to the weight loss impact of gastric bypass since we see that the sleeve benefits from removal of a large section of stomach, but in fact, there was not any weight loss impact and just a bit higher complication rate from the "extra" surgery.
Kinda misleading as even though there is no malabsorption of macronutrients there IS malabsorption of many micronutrients which are just as important as fat, protein and carbohydrate intake.
Question on malabsorption. When it comes to iron is the area of the small intestine that absorbs iron the duodenum? Would a 100 cm bypass still bypass the duodenum area of the small intestine? Hoping to better understand iron absorption as it relates to rny. This would make a great video! Thanks.
You ask an intelligent question, and it's good to know that for ALL gastric bypass cases there is reduced absorption of Iron. Also note that Sleeve reduces absorption of Iron because of the reduced acid in the stomach to "prepare" the Iron for absorption. You may want a deeper dive with this article: www.ncbi.nlm.nih.gov/books/NBK448204/#:~:text=The%20absorption%20of%20most%20dietary,a%20protein%20such%20as%20heme.
Hello doc pls reply me i am an indian and looking for this bariatric surgery. I am unmarried and i have wedding after 1 year which bariatric surgery will be beneficial for me sleeve or gastric bypass rxy? I m 32 yr old my weight is 95 kg (210 pounds) I have high cholesterol and pcos . Want to have babies in future. Pls reply which bariatric surgery would be safe for me? Love from india.
They can both be good options, with the right follow up. You may want to look at this video: ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-coLNhi4k3uI.html
Is it beneficial to have a super greens drink for more nutrients or will it just go straight through me. I’ve had the gastric bypass surgery and I’m feeling weak and needing a boost
Thanks for your question. There have been opinions that nutrition problems after bariatric surgery (any of them) can cause dental issues, but in my experience dental problems only occur if the patient has ongoing problems with throwing up. Constant vomiting of this type is NOT expected after bariatric surgery, so if this happens one should work with their bariatric team to correct the problem. Best of luck on your journey!
It's actually a complicated question. If your gastric bypass was done with a goal of malabsorption (not a standard gastric bypass) then perhaps the intestine can be revised. You would need to connect with your surgeon who did the operation.
nope gastric bypass 9 months post op I have terrible gas, i go 3 or 4 times a day and im taking iron pills,,, i definitely malabsorb, the iron pills make me go more?
Hi Lisa, just for clarity the video does indicate that the gastric bypass and sleeve reduce absorption of Iron and B12. This video is teaching that absorption of proteins and healthy fats is normal for a standard gastric bypass. I see your note about bowel difficulties - this might be a form of dumping syndrome if you eat some starchy foods like rice or if you have chemicals like artificial sweeteners which can disrupt the normal colon bacteria. Best of luck for you!
Hello from New Zealand, Dr. Pilcher! I’ve been recommended a Fobi Pouch Roux-en-Y Gastric Bypass for best results or a Mini Gastric Bypass. Do you have an opinion on these types of surgery? Reading about the silastic ring confused me as it sounded similar to the gastric band, which no one does anymore.
Thanks for your question. I try not to weigh in strongly on operations where I don't have a lot of direct experience. I will say that the Fobi ring, or in general putting permanent artificial material around the gastrointestinal tract, has not produced reliable beneficial results as far as I can tell. I have a harder time commenting on the mini gastric bypass, since there is not one standardized procedure for this. I think the approach would be for you to ask your surgeon how long they've been doing the mini gastric bypass *exactly* the way they propose to do it for you, and ask them if they find any need for special nutrition treatment.
@@DoctorJP Thanks so much for your reply. Understand you are a busy man. It's really awesome that you put all the information out freely online as you do. Cheers John!
So sorry to hear that. Many patients find the vitamins go down easier if you let them sit out overnight before taking them. This seems to let some of the smell fade out into the atmosphere.
Usually, bariatric surgical patients can donate blood several years after their surgery. It is important to work with your bariatric team to make sure that your nutrition and your vitamins are all up to speed before blood donation.
I have my Mini bypass operation in a couple of days… I didn’t understand from your video: is mini gastric bypass malapsorbtive or not? Sorry, you mentioned it in your video, but it wasn’t clear (at least to me) if the mini bypass was same to regular one in that sense? Waiting for your answer very much as my operation in coming very soon
Thanks for your question. I'm unable to answer since to my knowledge there is not a standardized mini gastric bypass. Some of them are malabsorptive, and some are not. You would need to ask your Bariatric Surgeon.
That is a good thoughtful question. Both the Sleeve and the Gastric Bypass work through a combination of restrictive (smaller stomach) and hormonal mechanisms. There are many other similarities, but also some differences that can be important for some patients. For more information, you might check this comparison video ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-F5YDrqon7G0.html
Dr Pilcher, I'm booked for gastric bypass surgery but I wonder about Ghrelin. If the stomach is left behind in gastric bypass, wouldn't the stomach in a shrinked state just excessively trigger Ghrelin production and hunger post surgery? I was really hoping too that gastric bypass had a malabsorptive effect, but at least now I'm informed. I would say at least 90% of bariatric surgeons in my country (Australia) still market the bypass as being malabsorptive to calories etc which probably should be addressed. Thanks, Clinton
Hello Clinton, you are asking an insightful question about ghrelin. My understanding is that the gastric bypass does also have a hormonal affect, but that it works through different mechanisms. Maybe take a look at this video: ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-nkHnYUyMyxQ.html
