I had WLS and can't lose - did I mess up my metabolism?

catecholamine

Please don't lose your *kitten* all over me because I had WLS.

tl;dr eat ~1500 calories a day, but don't absorb like 1/2 of that, my TDEE is 2575 calories. Why in the hell have I not lost any weight in 2 months? I've been losing and gaining the same few lbs.
Long story:

Good news: Diabetes was gone instantly, left hospital on no diabetes meds. High blood pressure is better. Sciatica is better. Arthritis is better. I've lost 110lbs.
Bad news: I still have like 90 to 100lbs to go. I'm still really big, and I've not lost weight for about 2 months, and before that for a few months it was 5lb/month. I'm a year out from surgery - Specifically, I had the Duodenal Switch, which statistically has the best numbers for losing weight and keeping it off long term, as well as diabetes resolution.
It has a different diet from someone with gastric bypass or sleeve. We heavily malabsorb fat - 80% is malabsorbed, though it can vary as low as 50% malabsorbed depending on the person. You also don't absorb 40% of protein, so you need at least 100g a day. Malabsorb 40% complex carbs, but FULLY absorb simple carbs. Also, over 100g carbs/day gives me an upset stomach.

I tell you this to explain why I eat a low carb, high protein, moderate fat diet. I don't eat a lot of vegetables because protein takes priority, but I take a lot of vites and my levels are all good.
Even if I had zero malabsorption, I should be losing weight. I haven't logged in a while on MFP, been logging elsewhere, so don't bother with my diary, but when I was logging here, most days were around 1500 calories before any sort of malabsorption, Today, for instance, I'm up to 793 calories for the day once I finish my dinner, and will have a protein bar and a shake to get my protein in. My TDEE is 2575 calories.

If this is the case, why am I not losing weight? I can tell for 100% sure I am not absorbing some amount of fat (TMI, I see a greasy sheen in the toilet and poop floats from the fat)

Is my metabolism just EFFED? I have PCOS and hypothyroidism, but the hypothyroidism is being treated (not much they can do about the PCOS). I weigh/measure my food and such to get a good idea about how much I'm eating. After malabsorption, I'm likely only getting 600 or 700 calories. Yeah, I'm tired all the time, but I was before surgery too. I literally could lose weight faster before the WLS, just couldn't keep it off. What the heck?

missiontofitness

I know this is a really generic response, but because it involves WLS (and one that rerouted your gut), I would definitely have this conversation with your doctor. Since you're still alive and posting, your metabolism is indeed working. Given that you have a combination of medical conditions that can affect weight loss mixed with a surgery that is supposed to be a weight loss tool, definitely get to your doctor asap to discuss next steps.

Christine_72

Sorry, what does WLS stand for?

missiontofitness

christinev297 wrote: »

Sorry, what does WLS stand for?

Weight loss surgery.

catecholamine

I have discussed it with my surgeon. He basically said there's nothing more he can do. He said to just keep doing what I'm doing. Well, what I'm doing is not working. I've had to change my eating, get a check on my emotional eating, and had to gain some serious willpower, not to mention how horribly painful the surgery was. I've worked hard, really hard, and I'm so, so disappointed that I'm still so far from my goal and I'm not losing anything anymore. I've tried eating less. I cut my calories down to ~700 a day for 2 weeks. I gained 3lbs. I don't know how that is scientifically possible. If someone else told me that, I'd think they're lying or kidding themselves, but it happened to me, and I was weighing my food and being really anal about it.

missiontofitness

catecholamine wrote: »

I have discussed it with my surgeon. He basically said there's nothing more he can do. He said to just keep doing what I'm doing. Well, what I'm doing is not working. I've had to change my eating, get a check on my emotional eating, and had to gain some serious willpower, not to mention how horribly painful the surgery was. I've worked hard, really hard, and I'm so, so disappointed that I'm still so far from my goal and I'm not losing anything anymore. I've tried eating less. I cut my calories down to ~700 a day for 2 weeks. I gained 3lbs. I don't know how that is scientifically possible. If someone else told me that, I'd think they're lying or kidding themselves, but it happened to me, and I was weighing my food and being really anal about it.

Have you tried working with a nutritionist or dietician who specializes in WLS patients? Also, you say you weigh your food; are you using USDA entries, and entries without an asterisk next to them?

JPW1990

PCOS will be a factor, you also need to go get your absorption checked - it's not just about your macros. It is possible you're losing weight but retaining more water than you're losing, or that other complications are causing a similar effect via other fluids. IOW, internet can't really help you with this one. Seriously, call the doctor.

azulvioleta6

As someone with metabolic disorders (PCOS, hypothyroidism), the standard BMR and TDEE calculations will not ever be correct for you. The real number is smaller.

You don't mention exercise at all. What are you doing on a weekly basis?

I have more involved issues than you do, but I know that my BMR is 25% of what it should be. I make up for it by exercising, a lot. I also pack as much nutrition as possible into the few calories that I do eat--rarely any simple carbs, all real foods, lots of veggies. I absolutely cannot get below a particular weight (about 30 pounds above my goal weight) unless I get ten veggies a day. Not sure how helpful that is for you given your dietary restrictions.

What kind of feedback are you getting from your endocrinologist and your bariatric doctor?

catecholamine

I'm not joking when I say this - there is not one single nutritionist that I'm aware of in my whole state that is educated on what someone with DS should eat. It's very different from sleeve or gastric bypass - it's heavier in fat and protein, some DS'ers eat 3,000+ calories a day - most coming from fat and protein. The nutritionist at my surgeon's office doesn't know jack about the DS. She gives everyone the same advice, including with vitamins. If I followed her vitamin advice, all my levels would be in the tank. I take 3x-10x the daily amounts on fat soluable vitamins than she recommends, and they are just barely in range. Most DS patients online agree with this: most nuts are not trained or knowledgeable of what a person who had the DS should eat. I did try her recommendations though, just because. It didn't help. Tried it for 1 1/2 months.

Zara11

find one in another state and have calls/video conferences?

azulvioleta6

Uggg, how frustrating. I believe you.

My solution when I find that the medical professionals that I am working with are not doing a good job is to go to the nearest medical school and/or find the BEST specialist in my state for a particular issue. That can make an enormous difference.

catecholamine

I don't see an endo, my PCP manages my hypothyroidism/PCOS. I can't eat a lot of veggies - my stomach doesn't have much space now. Most of what I eat is meat or cheese for the protein. I exercise anywhere from 2-5 times a week for 45min to a little over an hour, depending on how I'm feeling and what I can tolerate that day. There is no way to test how much I absorb nutrients, one can only guesstimate based on the estimated malabsorption that some docs came up with, people call it "DS Math". The things is, I AM malabsorbing, I can actually see the malabsorbed fat (yep, gross). So I'm likely absorbing 600-800 calories a day. And I'm not losing. I eat less than 50g total carbs a day (not net). I tried eating less, and that certainly didn't work. I've had some DS'ers tell me I need to force protein and fat and eat more than I do. I just hate forcing food when I'm not hungry - and I'm skeptical that eating more could make me lose weight.
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catecholamine

Well...there's the issue of money. I can't afford to see a nut and my insurance does not cover it. I live off $760/month - and I pay my own rent, car insurance, all my bills. There's only really enough left over to buy my vites/protein powder. I had to pay an $1,800 fee for the surgery that covered a year's worth the nut visits. Those turned out to be useless, but even if they weren't, my year is up. My surgery was Jan 22, 2014.

JPW1990

catecholamine wrote: »

I don't see an endo, my PCP manages my hypothyroidism/PCOS. I can't eat a lot of veggies - my stomach doesn't have much space now. Most of what I eat is meat or cheese for the protein. I exercise anywhere from 2-5 times a week for 45min to a little over an hour, depending on how I'm feeling and what I can tolerate that day. There is no way to test how much I absorb nutrients, one can only guesstimate based on the estimated malabsorption that some docs came up with, people call it "DS Math". The things is, I AM malabsorbing, I can actually see the malabsorbed fat (yep, gross). So I'm likely absorbing 600-800 calories a day. And I'm not losing. I eat less than 50g total carbs a day (not net). I tried eating less, and that certainly didn't work. I've had some DS'ers tell me I need to force protein and fat and eat more than I do. I just hate forcing food when I'm not hungry - and I'm skeptical that eating more could make me lose weight.
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Are you getting your protein in early? This might fall under the differences between DS and RNY issue, but the one thing they beat into me from the start was bulk of the protein early in the day, then the rest.

NJGamerChick

Eating more can make you lose. I did it once and if I didn't feel like I was going to pass out before lunch from so much food, I'd be skinny by now. Can't really look at your diary since there are some incomplete days.

catecholamine

JPW1990 wrote: »

Are you getting your protein in early? This might fall under the differences between DS and RNY issue, but the one thing they beat into me from the start was bulk of the protein early in the day, then the rest.

I have to get more protein than a RNY, but every single meal is protein based. I am a night owl, so my first meal is usually lunch when I wake up. Every meal has more protein than anything else - unless it has more fat, which is okay.

azulvioleta6

catecholamine wrote: »

I don't see an endo, my PCP manages my hypothyroidism/PCOS.
-

Ah, find the best endocrinologist you can get to and make an appointment. Your issues are way too complex for a PCP.

Yeah, I get that veggies are not going to be an easy solution for you...but I wonder if some of the problem is generally in that you are eating fairly constipating things and perhaps not getting enough fiber.

On your own, you can experiment with adding more exercise. I aim for an hour a day of casual exercise (walking, for example) and an hour a day of something more intense. I don't reach that goal every day, but I come close. I alternate high and low impact to extend what I am able to do.

You could also experiment with reducing your calorie intake by a couple of hundred calories a day.

catecholamine

Fat works like fiber for DS'ers. Constipated? Eat fat. That's what we do. And it works. That's why my surgeon's nutritionist's advice to eat low fat was stupid. She couldn't tell me why I should eat low fat - while everything on the internet says moderate fat - just that I "shouldn't eat it just because I don't absorb it"...which makes no sense. I did low calorie, low fat for 1 1/2 months. I was taking miralax, laxatives, and fiber supplements EVERY DAY!! It was a constant struggle. And I did not lose a single pound during that period, just gained because the poo backlog. I'm telling you, reducing my calories doesn't help. I've had a weight loss only twice since the end of October. I went away for 4 days for thanksgiving, came home and I'd lost 4lbs. No weight loss until I went away for Christmas and came home 4lbs less again. I don't know if that means I should eat more or what, because on both times we had multiple big meals. I don't know. Sigh...

ominousdusk

Did you say your TDEE is 2500 but you are only eating 1500? How do you expect to lose weight and burn fart if your body needs every single calorie you are giving it? You aren't feeding it enough nutrients so its going to hold on to everything. It is physically possible to gain weight from not eating enough. I don't have any health issues but if i eat below my BMR (which is 1800) I don't lose weight, and if I do this long enough I will gain. Eating below your BMR you will lose but then eventually you will lose more slowly and then not at all. You will lose lean muscle mass instead of fat and when you start to eat to maintain you will gain weight again.

catecholamine

Some people on DS boards/groups have told me I should eat more. Others said to just do what I'm doing. It's hard for me to eat more - I eat when I'm hungry and I can only eat so much at one time. I hate forcing food when I'm not hungry.

NotGnarly

I had the sleeve so my dietary needs are way different than yours. I had sleeve surgery about 2.5 years ago and gained back about 15 pounds. I know that my years of low cals and not lifting weights has caused me to lose muscle. My thighs literally felt like mush. My advice is maybe your metabolism has slowed since you may be carrying less muscle. I know mine slowed down and no matter what I tried the scale wouldn't budge but thankfully now it's moving.