Modified Duodenal Switch

[Clueless_girl 17]

Wow. Maybe the surgeon, nurses, and dieticians didn't go over any of this with me because they were focused on fixing my nausea and pain? But I'm going to have to ask a lot of questions on my next followup in a few weeks.

"Reframing" is the perfect way to put it! Now, how to figure out how to do that 🤔...

[ShoppGirl 4,785]

Hello everyone. I think I finally found the forum I am looking for. Is the SADI S fhe same thing as the SADI?? I had gastric sleeve three years ago and was looking to convert to bypass but My dr told me today to start researching the SADI procedure.

[ChunkCat 728]

23 hours ago, ShoppGirl said:

Hello everyone. I think I finally found the forum I am looking for. Is the SADI S fhe same thing as the SADI?? I had gastric sleeve three years ago and was looking to convert to bypass but My dr told me today to start researching the SADI procedure.

Yes, the SADI-S and SADI are the same procedure! When you are converting from a gastric sleeve you can either convert to bypass, convert to SADI, or convert to a Duodenal Switch. All 3 impact the small intestines, they vary by degrees of malabsorption. SADI is in the middle of the 3 in terms of malabsorption and doesn't require changing the stomach like the bypass would. They'd just be going in to do the small intestine component. It's a great option for a revision.

[ChunkCat 728]

On 3/8/2024 at 10:05 PM, Clueless_girl said:

Wow. Maybe the surgeon, nurses, and dieticians didn't go over any of this with me because they were focused on fixing my nausea and pain? But I'm going to have to ask a lot of questions on my next followup in a few weeks.

"Reframing" is the perfect way to put it! Now, how to figure out how to do that 🤔...

I posted this elsewhere on the forum but I thought I'd put it here in case you didn't see it.

This is what one of my typical days looks like at 4 months post-op. My personal macro goal is 120-150 grams of Protein a day, under 50 total carbs, and 100 grams of fat. Also, I can't tolerate any raw fruit at the moment. And calories are not relevant for DS patients because we malabsorb most fat and a good chunk of our protein...

8 am: Premier Protein Cafe Latte shake

9 am: Ratio Keto vanilla Yogurt with 2 tablespoons of toasted coconut chips, 1 tablespoon of Keto nut granola, and 1 tablespoon freeze dried strawberries

12 noon: 1/4 cup roasted Spaghetti Squash, 1/4 cup of ricotta cheese, 1/4 cup of a beef bolognese sauce

2 pm: Cafe Macchiato with espresso and 4 oz Fairlife Protein Milk

3 pm: 2 mozzarella cheese sticks, 2 mini baby cucumbers and 4 cherry tomatoes

6 pm: Roasted chicken leg and thigh quarter, 1/3 cup of vegetable Soup

9 pm: Homemade Keto banana Walnut Dark chocolate Muffin

Total Macros: 150 grams of protein (yay!!), 43 grams total carbs, 97 grams of fat, 1634 calories.

[ShoppGirl 4,785]

14 minutes ago, ChunkCat said:

I posted this elsewhere on the forum but I thought I'd put it here in case you didn't see it.

This is what one of my typical days looks like at 4 months post-op. My personal macro goal is 120-150 grams of Protein a day, under 50 total carbs, and 100 grams of fat. Also, I can't tolerate any raw fruit at the moment. And calories are not relevant for DS patients because we malabsorb most fat and a good chunk of our protein...

8 am: Premier Protein Cafe Latte shake

9 am: Ratio Keto vanilla Yogurt with 2 tablespoons of toasted coconut chips, 1 tablespoon of Keto nut granola, and 1 tablespoon freeze dried strawberries

12 noon: 1/4 cup roasted Spaghetti Squash, 1/4 cup of ricotta cheese, 1/4 cup of a beef bolognese sauce

2 pm: Cafe Macchiato with espresso and 4 oz Fairlife Protein Milk

3 pm: 2 mozzarella cheese sticks, 2 mini baby cucumbers and 4 cherry tomatoes

6 pm: Roasted chicken leg and thigh quarter, 1/3 cup of vegetable Soup

9 pm: Homemade Keto banana Walnut Dark chocolate Muffin

Total Macros: 150 grams of Protein (yay!!), 43 grams total carbs, 97 grams of fat, 1634 calories.

Two questions. One I thought I read somewhere that caffeine was a no no post SADI?? Or was it just carbonation, maybe. After I gained it all back I started back on my Coke Zero and I have to kick that again pre op if sugar alcohol is bad. I gave it up for over two years so I can do it though. Second, , have you eaten out yet? If so, How are you with oils and stuff that they tend to sneak in even the “healthier options” I am a little worried I won’t be able to eat in public ever again.

[ChunkCat 728]

1 hour ago, ShoppGirl said:

Two questions. One I thought I read somewhere that caffeine was a no no post SADI?? Or was it just carbonation, maybe. After I gained it all back I started back on my Coke Zero and I have to kick that again pre op if sugar alcohol is bad. I gave it up for over two years so I can do it though. Second, , have you eaten out yet? If so, How are you with oils and stuff that they tend to sneak in even the “healthier options” I am a little worried I won’t be able to eat in public ever again.

Caffeine is usually restricted for the first few months in a virgin DS/SADI surgery to help prevent dehydration. You may not have this restriction put on you since you already have your sleeve and should keep food and fluids down fine post-op since they probably won't resleeve you unless yours was done wrong. Even if they put you on caffeine restriction, it is only for a little while. There is no reason to restrict it long term, it doesn't harm the digestive system.

My partner loves to dine out and we don't have kids, so I've been eating out since a month after surgery. I am careful with my choices, the first thing I ate out was grilled swordfish and sauteed green Beans. It was fine. I've since eaten Thai curries (mild), pho without the noodles (they put veggies instead), sashimi, fajitas with guacamole and cheese sauce (no tortillas, rice, or beans), steak (ribeye is my favorite and digests better now than it even did pre-op), wings, traditional Chinese food (nothing fried, no rice), Peruvian chicken, the list goes on and on. I try to stick to protein/veggie options. Anything I wanted to eat at a restaurant I tried to have a version of at home first to know how it would affect me. I tolerate most things pretty well, though it seems my digestive system prefers baby spinach over iceburg or romaine lettuce, but that's not a huge sacrifice. And I can't eat beans at all, but I never really tolerated them pre-op either. Also I try not to have too many cruciferous veggies at once (broccoli, cauliflower, cabbage), as they cause bloating, but I had that problem before surgery too. (I have had IBS and an inflammatory bowel disease since I was a teenager.)

That said I try to make healthy choices in general whether eating out or eating at home. DS patients don't really need to restrict fat because we malabsorb so much of it (regardless of what the dieticians tell you) and SADI patients can eat a moderate amount of fat as they malabsorb a moderate amount of fat. Too much fat in one sitting can cause diarrhea, but you'd have to really make an effort to do that, and any bariatric surgery other than the sleeve can cause that issue.

Coke Zero does not have sugar alcohols in it, it has Splenda, so it is fine from that perspective. Carbonation is only an issue if it bloats your sleeve. However, it can cause you to be hungry faster, or cause gas due to the air bubbles, so it isn't the best habit to have long term. But it won't piss off your intestines. I switched to unsweetened iced tea and carry Splenda or Equal packets with me! Sugar alcohols are things like erythritol, xylitol, and malitol. Allulose can also cause gastric upset depending on how tolerant you are of it. I can usually have a little of any of those, but more than a tablespoon and I'll be in the bathroom half the night. 🤣

[ShoppGirl 4,785]

6 minutes ago, ChunkCat said:

Caffeine is usually restricted for the first few months in a virgin DS/SADI surgery to help prevent dehydration. You may not have this restriction put on you since you already have your sleeve and should keep food and fluids down fine post-op since they probably won't resleeve you unless yours was done wrong. Even if they put you on caffeine restriction, it is only for a little while. There is no reason to restrict it long term, it doesn't harm the digestive system.

My partner loves to dine out and we don't have kids, so I've been eating out since a month after surgery. I am careful with my choices, the first thing I ate out was grilled swordfish and sauteed green Beans. It was fine. I've since eaten Thai curries (mild), pho without the noodles (they put veggies instead), sashimi, fajitas with guacamole and cheese sauce (no tortillas, rice, or beans), steak (ribeye is my favorite and digests better now than it even did pre-op), wings, traditional Chinese food (nothing fried, no rice), Peruvian chicken, the list goes on and on. I try to stick to protein/veggie options. Anything I wanted to eat at a restaurant I tried to have a version of at home first to know how it would affect me. I tolerate most things pretty well, though it seems my digestive system prefers baby spinach over iceburg or romaine lettuce, but that's not a huge sacrifice. And I can't eat Beans at all, but I never really tolerated them pre-op either. Also I try not to have too many cruciferous veggies at once (broccoli, cauliflower, cabbage), as they cause bloating, but I had that problem before surgery too. (I have had IBS and an inflammatory bowel disease since I was a teenager.)

That said I try to make healthy choices in general whether eating out or eating at home. DS patients don't really need to restrict fat because we malabsorb so much of it (regardless of what the dieticians tell you) and SADI patients can eat a moderate amount of fat as they malabsorb a moderate amount of fat. Too much fat in one sitting can cause diarrhea, but you'd have to really make an effort to do that, and any bariatric surgery other than the sleeve can cause that issue.

Coke Zero does not have sugar alcohols in it, it has Splenda, so it is fine from that perspective. Carbonation is only an issue if it bloats your sleeve. However, it can cause you to be hungry faster, or cause gas due to the air bubbles, so it isn't the best habit to have long term. But it won't piss off your intestines. I switched to unsweetened iced tea and carry Splenda or Equal packets with me! Sugar alcohols are things like erythritol, xylitol, and malitol. Allulose can also cause gastric upset depending on how tolerant you are of it. I can usually have a little of any of those, but more than a tablespoon and I'll be in the bathroom half the night. 🤣

lol. You reminded me of the sugar free Gummy bears I didn’t have an issue with them but I didn’t like them so I didn’t have but one maybe two. I sent them home with my friend who was living a couple of hours away so she ate the rest of the pack on her way home 😂 . She now buys those instead of bothering with Fiber or laxatives when she is constipated she swears they work better.

I am really hoping that my sleeve is still okay. That’s one of my questions for the surgeon is what happens if he goes in and it’s bigger than it should be. He is the one that don’t it and he is known As an excellent surgeon but For whatever reason I could eat more than I should’ve been able to at every given stage from day one when I was drinking without any issue. I also had very little pain post op so maybe I just advanced through the stages faster because of less swelling or something?? At first I questioned whether they even did the surgery but I definitely do haxe Restriction it’s just not as much as some peoples

Anyways, I definitely need to save this post for future reference. In terms of all the dining out options and potential trigger foods this is such valuable information!!

[ShoppGirl 4,785]

On 3/19/2024 at 9:00 PM, ChunkCat said:

I posted this elsewhere on the forum but I thought I'd put it here in case you didn't see it.

This is what one of my typical days looks like at 4 months post-op. My personal macro goal is 120-150 grams of Protein a day, under 50 total carbs, and 100 grams of fat. Also, I can't tolerate any raw fruit at the moment. And calories are not relevant for DS patients because we malabsorb most fat and a good chunk of our protein...

8 am: Premier Protein Cafe Latte shake

9 am: Ratio Keto vanilla Yogurt with 2 tablespoons of toasted coconut chips, 1 tablespoon of Keto nut granola, and 1 tablespoon freeze dried strawberries

12 noon: 1/4 cup roasted Spaghetti Squash, 1/4 cup of ricotta cheese, 1/4 cup of a beef bolognese sauce

2 pm: Cafe Macchiato with espresso and 4 oz Fairlife Protein Milk

3 pm: 2 mozzarella cheese sticks, 2 mini baby cucumbers and 4 cherry tomatoes

6 pm: Roasted chicken leg and thigh quarter, 1/3 cup of vegetable Soup

9 pm: Homemade Keto banana Walnut Dark chocolate Muffin

Total Macros: 150 grams of Protein (yay!!), 43 grams total carbs, 97 grams of fat, 1634 calories.

So I finally got an email back from My dietician and the macros she gave me for diet post Sadi is 1000-1200 calories 90g protein 90g carbs and 15 grams of fat. That doesn’t seem to be anything close to yours. I am so confused and wondering if she is wrong. I feel like if I don’t absorb a descent pirtion of that I would be malnourished.

Edited April 27 by ShoppGirl

[ChunkCat 728]

38 minutes ago, ShoppGirl said:

So I finally got an email back from My dietician and the macros she gave me for diet post Sadi is 1000-1200 calories 90g Protein 90g carbs and 15 grams of fat. That doesn’t seem to be anything close to yours. I am so confused and wondering if she is wrong. I feel like if I don’t absorb a descent pirtion of that I would be malnourished.

I have yet to see a nutritionist or dietician that truly understands the optimal diet for a SADI or DS patient. Most of the time we just get a modified version of what they give Bypass and Sleeve patients. But as you say, you aren't absorbing as much as they are, therefore to give you their requirements would leave you malnourished.

15 grams of fat is absurd by all medical standards. Most medical studies show we need 60 grams of fat for proper hormone function and even if you ate 60 grams of fat, with an altered digestive tract, you aren't absorbing that much, so you need to eat a little more than that. Even the ASMBS recommends 60 grams of fat by 1 year out!! Your dietician is not following best practices.

Most SADI/DS patients I know follow the vets that have been living with this surgery for 10+ years and maintaining their weight loss. We figure they know more about optimal diet than a surgeon who has never lived with this surgery, or a dietician that has never even researched best diet for bariatric patients of various surgeries. Most patients I know are eating 100-120 grams of protein, less than 50 grams of carbs, and over 60 grams of fat, usually around 100 grams of fat for SADI and 150 grams for DS. You can increase your carbs once you have reached your goal weight, they tend to slow/stop weight loss, so in active weight loss it is important to keep them low so you stay in ketosis.

A calorie range makes dieticians feel better, but it makes no sense for a SADI or DS patient because we malabsorb so much fat we can't even begin to properly calculate our calories. You could eat 1200 calories, but that wouldn't be what your body is absorbing.

I'm sorry this is so complicated. In the end you have to decide what you feel best at. I don't feel good following guidelines like your dietician gave you and when I go over 50 grams of carbs I stop losing weight. So...yeah. I'm going to follow what allows my brain and hormones to function, what makes my skin, hair, and eyes feel best, what gives me the most energy, and what allows me to lose weight steadily. I'm the one that has to live in this body. It is sad these surgeries are so uncommon there are no good studies about optimal nutrition for them. But there is no way I'd go below ASMBS guidelines, they are the closest thing bariatric surgeons have to a standardizing body. Your dietician should be able to give you ASMBS guidelines for your surgery.

[ShoppGirl 4,785]

20 minutes ago, ChunkCat said:

I have yet to see a nutritionist or dietician that truly understands the optimal diet for a SADI or DS patient. Most of the time we just get a modified version of what they give Bypass and Sleeve patients. But as you say, you aren't absorbing as much as they are, therefore to give you their requirements would leave you malnourished.

15 grams of fat is absurd by all medical standards. Most medical studies show we need 60 grams of fat for proper hormone function and even if you ate 60 grams of fat, with an altered digestive tract, you aren't absorbing that much, so you need to eat a little more than that. Even the ASMBS recommends 60 grams of fat by 1 year out!! Your dietician is not following best practices.

Most SADI/DS patients I know follow the vets that have been living with this surgery for 10+ years and maintaining their weight loss. We figure they know more about optimal diet than a surgeon who has never lived with this surgery, or a dietician that has never even researched best diet for bariatric patients of various surgeries. Most patients I know are eating 100-120 grams of Protein, less than 50 grams of carbs, and over 60 grams of fat, usually around 100 grams of fat for SADI and 150 grams for DS. You can increase your carbs once you have reached your goal weight, they tend to slow/stop weight loss, so in active weight loss it is important to keep them low so you stay in ketosis.

A calorie range makes dieticians feel better, but it makes no sense for a SADI or DS patient because we malabsorb so much fat we can't even begin to properly calculate our calories. You could eat 1200 calories, but that wouldn't be what your body is absorbing.

I'm sorry this is so complicated. In the end you have to decide what you feel best at. I don't feel good following guidelines like your dietician gave you and when I go over 50 grams of carbs I stop losing weight. So...yeah. I'm going to follow what allows my brain and hormones to function, what makes my skin, hair, and eyes feel best, what gives me the most energy, and what allows me to lose weight steadily. I'm the one that has to live in this body. It is sad these surgeries are so uncommon there are no good studies about optimal nutrition for them. But there is no way I'd go below ASMBS guidelines, they are the closest thing bariatric surgeons have to a standardizing body. Your dietician should be able to give you ASMBS guidelines for your surgery.

I’m trying my best to mimic what I will be eating post surgery and today I logged my food and just mostly paid attention to carbs and protein. I logged but otherwise ignored the fat for now since I thought she was wrong. In the morning I had a Protein Shake with coffee. For lunch I had two scrambled eggs with Turkey sausage, morning snack was a dannon light and fit yogurt, dinner was taco salad with pepper, onion, 1/3 cup cheese, 1/4 avacado and 4 oz lean taco meat. Then a chobani flip yogurt for snack which is the worst thing of the day because of that little bit of chocolate and Peanut Butter I guess. Anyways i added that to be 61g carbs (23 was that yogurt), 54.4g fat, and 105.5g protein. I am thinking I was close. Maybe adding a little more healthy fat such as more avocado or cheese or cooking with olive oil instead of pam spray and then switching out that evening yogurt with a lower carb one and I would’ve been pretty close to you. I realize as I’m going over this that I’m going to have to tweak this quite a bit for a smaller pouch if my surgeon re-sleeves me which I hope he does. This is going to take some time to figure out. Thank you so much for all of your help.

[Postop 411]

On 4/26/2024 at 10:26 PM, ChunkCat said:

I have yet to see a nutritionist or dietician that truly understands the optimal diet for a SADI or DS patient. Most of the time we just get a modified version of what they give Bypass and Sleeve patients. But as you say, you aren't absorbing as much as they are, therefore to give you their requirements would leave you malnourished.

15 grams of fat is absurd by all medical standards. Most medical studies show we need 60 grams of fat for proper hormone function and even if you ate 60 grams of fat, with an altered digestive tract, you aren't absorbing that much, so you need to eat a little more than that. Even the ASMBS recommends 60 grams of fat by 1 year out!! Your dietician is not following best practices.

Most SADI/DS patients I know follow the vets that have been living with this surgery for 10+ years and maintaining their weight loss. We figure they know more about optimal diet than a surgeon who has never lived with this surgery, or a dietician that has never even researched best diet for bariatric patients of various surgeries. Most patients I know are eating 100-120 grams of Protein, less than 50 grams of carbs, and over 60 grams of fat, usually around 100 grams of fat for SADI and 150 grams for DS. You can increase your carbs once you have reached your goal weight, they tend to slow/stop weight loss, so in active weight loss it is important to keep them low so you stay in ketosis.

A calorie range makes dieticians feel better, but it makes no sense for a SADI or DS patient because we malabsorb so much fat we can't even begin to properly calculate our calories. You could eat 1200 calories, but that wouldn't be what your body is absorbing.

I'm sorry this is so complicated. In the end you have to decide what you feel best at. I don't feel good following guidelines like your dietician gave you and when I go over 50 grams of carbs I stop losing weight. So...yeah. I'm going to follow what allows my brain and hormones to function, what makes my skin, hair, and eyes feel best, what gives me the most energy, and what allows me to lose weight steadily. I'm the one that has to live in this body. It is sad these surgeries are so uncommon there are no good studies about optimal nutrition for them. But there is no way I'd go below ASMBS guidelines, they are the closest thing bariatric surgeons have to a standardizing body. Your dietician should be able to give you ASMBS guidelines for your surgery.

I kind of agree. My nut. helped in the beginning, but then it was vets who pointed the way.

[Wellington4321 24]

A few thoughts from my Sadi experience after nearly 10 years:

- Nutritionists are like driving instructors who read a book about driving but never drove themselves. The same can be said for many doctors since only weight loss specialists understand the procedures.

- Eat the basics everyday (protein, fruit, fiber), then mostly anything else.

- Hydration is vital, I get mine from fruits, tea and Water. I eat between 20 to 30 lbs of fruit per week (not kidding). It doesn't add weight.

- Get exercise everyday, even just steps are fine.

I'm a 6'1 male, 63 yrs old, weigh about 166lbs today. I lost about 152 lbs in year 1, gained back 25lbs after 3 years. Recently gained about 5lbs but working out a lot. I prioritize eating the basics daily, taking the Vitamins (less than a DS'er), then eat whatever I want. I get exercise everyday by walking my dog, hikes, biking and going to the gym. It took me about 4 years to get in decent shape after surgery. Now workouts are just a thing I do everyday like any other activity.

[ShoppGirl 4,785]

9 hours ago, Wellington4321 said:

A few thoughts from my Sadi experience after nearly 10 years:

- Nutritionists are like driving instructors who read a book about driving but never drove themselves. The same can be said for many doctors since only weight loss specialists understand the procedures.

- Eat the basics everyday (protein, fruit, fiber), then mostly anything else.

- Hydration is vital, I get mine from fruits, tea and Water. I eat between 20 to 30 lbs of fruit per week (not kidding). It doesn't add weight.

- Get exercise everyday, even just steps are fine.

I'm a 6'1 male, 63 yrs old, weigh about 166lbs today. I lost about 152 lbs in year 1, gained back 25lbs after 3 years. Recently gained about 5lbs but working out a lot. I prioritize eating the basics daily, taking the Vitamins (less than a DS'er), then eat whatever I want. I get exercise everyday by walking my dog, hikes, biking and going to the gym. It took me about 4 years to get in decent shape after surgery. Now workouts are just a thing I do everyday like any other activity.

Congratulations on your loss and thanks for your input (I love your comparison to driving instructors who have never actually drove). If you don’t mind me asking does that amount of fruit cause bathroom issues? I think it was the Fiber that I read if you have too much after SADI it causes malodorous gas. Also, can you please give me an example of a day for you (in terms of food)?

[Wellington4321 24]

17 hours ago, ShoppGirl said:

Congratulations on your loss and thanks for your input (I love your comparison to driving instructors who have never actually drove). If you don’t mind me asking does that amount of fruit cause bathroom issues? I think it was the Fiber that I read if you have too much after SADI it causes malodorous gas. Also, can you please give me an example of a day for you (in terms of food)?

You're correct to be aware of bathroom issues but it's not a serious consideration for having the surgery. Consider yourself more lactose intolerant among a few other things and just eat around certain foods. The heavy consumption of fruit is important for me for hydration and feeling satisfied with food. The only gas triggers are grapes (red & green). I still eat them at home but not if I'm going to be in an office or public area like the gym. No issue eating berries, oranges, pinneapple, peaches, mango, grapefruit and most others. I'm not kidding about eating at least 20lbs a week of fruit, often way more. It's great for supplementing hydration and satisfies a sweet craving.

Edited April 30 by Wellington4321

[ShoppGirl 4,785]

Instead of posting this as a new topic I’m hoping to get the attention of those who have already had this surgery so I’m posting here. I have a question about SADI Vitamins but I think the experience of Duodenal switch is pretty close with vitamins.

So I thought I had really found something great when I came across the Pro Care health Sadi/ DS multi with Iron and ADEK. . Then I started googling and the 60mg of iron in them is toxic and potentially fatal for normal anatomy. I realize we won’t absorb as much of some vitamins but since we dont know exactly the degree of malabsorbtion would I be better to start with a little lower iron like 45mg and up it if my labs are low? I already ordered two bottles of those capsules because I had points from this forum and they sell them in the Bariatric Pal Store but now I’m thinking I may just take them a couple times a week or something. Just curious what amount if iron others take who are a little while out from SADI or DS.