[Mama]

I had my mind totally set on the DS... then I started getting cold feet and thinking the sleeve is safer and less extreme. I need to pick a surgery before I meet with a surgeon because if I pick the DS it will require travel whereas I can get a sleeve done more locally.

Anyone with a sleeve here? My big fear is weight regain and I know the data isn't in yet for that. Here is a pro/con list I'm working on...


Pros to DS vs VGS
Insurance will likely cover huge portion of bill
Been done for 20 yrs - long term results are known
Highest weight loss and maintenance of all WLS
Weight regain less likely, although not much data on VSG for this
Fastest weight loss... may lose 100 lbs in first 6 months
Highest resolution of comorbities - esp. diabetes
Can eat larger portions while in maintenance

Cons to DS vs VGS
No local support - Local support groups for VGS
Longer and more risky operation
Longer hospital stay and recovery
May have to take up to 30 supplements a day for the rest of my life or risk life-threatening consequences
DS is rare and will require explanations to doctors who get it confused with RNY
Must eat at least 100 grams protein and high fat diet - which can be difficult for a vegetarian
More pooping and farting - carbs cause uncomfortable gas
Other risks like bowel obstruction possible
Not modeling healthy diet for kids - such as eating low fat with lots of fruits and veggies


What other factors should I be thinking about? Oh.... FYI, I have almost 200 lbs to lose to get to a healthy weight but I'd be thrilled to lose around 120. I'm vegetarian. My co-morbidities include hypertension, fatty liver, and my glucose was 104 at the last check (not diabetes, but I could go that way).

I'm not looking to start a "surgery war" as different surgeries are better for different people... I just need help thinking through what is best for me from folks that have gone before me. Any comments are welcome and appreciated.


Thank you, awesome chickies!!!

[jiffypop]

Great list of pros and cons, Mama. and i tried to post a response last night, but my internet was cranky.

the VSG is the FIRST PART of the DS - the restrictive part. the DS adds the malabsorption. sooooo, the VSG can be TURNED INTO a DS later, if that becomes necessary. But that would mean TWO surgeries, and your insurance might not cover both, so that's also a consideration.

not sure if this info helps - but there it is!!! a lot of the choice comes down to how YOU choose to live for the rest of your life. Maybe adding another list about your PREFERENCES and your CAN'T TOLERATEs might help?

you're doing great with looking at all the issues here.

[Duckslove]

I cannot imagine being able to get enough proteihn as a vegitarian. beans just dont have even close to as much protien as chickn and beef. beans have about 9 grams per 3 ounce serving and chickn has 25 grams per 3 ounce serving (according to hte paper my doc sent home with me.) I imagine you should talk over the pro's and cons of both with your doc especially considering you are a vegitarian.

[SpookyXXL]

I have the DS and i dont eat a lot of fat, I take Whey protein (Nectar) drink milk and eat cheese and eat LEAN meats, when i eat anything fatty I feel sluggish a lot of times and dont eat fried food, I eat vegatable after 7 wks and I dont eat many baked goods but can have a little if I take gas-x.
ANY surgery you have is going to most likely be much more difficult with being a vegitarian but it is a choice and there are planty of whey and soy proteins out there.

[Mama]

Thanks for your replies! And WOW, spooky, you are doing awesome!! Way to go!!!

With two little kids the idea of being out of commission longer with the DS is even more daunting. And TWICE last week I forgot to take my prenatal vitamin (which I take since I am breastfeeding) so it makes me worry that I wouldn't be as consistent as required on the massive DS vitamin schedule. I'd probably get into it and get used to it, but with two little kids to keep up with I can see how easy it would be to forget a dose - which isn't acceptable for a DSer. If I can simply pop a few vitamins in the morning and be done with it, no problem... but if I needed to take pills four or five times a day for the rest of my life... I don't know if I have my act together enough for that. I'd most likely do just fine, but I have my doubts and vitamins are nothing to mess with. The nerd in me would LOVE the regular bloodwork and adjusting vitamin levels accordingly, though. LOL!

The DS diet is one of the biggest considerations for me. I could get my 100 grams of protein a day with shakes... but I have yet to meet a protein shake that doesn't make me gag. Also aside from eggs, cheese, and tofu (and I can only eat so much of those three thing before I, once again, gag. LOL!) fake meat is a major source of my protein. Garden burgers, meatless chicken, etc. etc. These are great sources of healthy protein BUT they also contain carbs... more carbs than (from what I can tell) most successful DSers allow themselves.

Jiffy - great question to think about my preferences vs. things I can't tolerate. I cannot tolerate eating meat. That's my only real no-no. I prefer to not drink protein shakes or bars, but I will if necessary. I prefer to not eat eggs more than a couple times a week (I just get sick if I eat eggs too frequently, don't know why...), but I can eat more frequently if necessary.

Spooky - it sounds like you are eating very healthfully! That's great! I read some message boards where DSers talk about their diets and it's mostly high fat and high meat content. Lots of bacon, full fat creams, butter, marbled meats, fried eggs, heavy sauces etc. None of that is appealing to me. They are losing weight and doing great, and I'm not judging them at all... but if that is the DS lifestyle I am just not interested. Maybe I am getting the wrong idea about DS diets, though. I know the Internet isn't always the best source of information because people that are more extreme in their practices are more likely (sometimes) to post. Someone is more likely to say "I ate five pounds of bacon yesterday and dropped two pounds overnight!" then they are to say "I ate a low fat whole grain diet and lost 2 lbs this week."

I think any surgery with malabsorption would be a challenge for a vegetarian... but maybe I am off base in my thinking. You are right, Duckslove, that many tasty vegetarian sources of protein have less protein than their meat counterparts. If malabsorption is also working against me in this department, I think getting in the recommended amount (which is higher for DSers than others) would be very difficult and come with a heavy carb pricetag. Or else I'd have to do a lot of protein shakes... which isn't what I want to do the rest of my life. I want to eat like a "normal person" - just much smaller quantities. A surgery that is purely restriction would help me with portion control which is what I really need. I eat very healthy foods, I really do... I just eat WAY too much of them!

I just keep thinking I'd be a better fit for VSG than DS. My insurance, sadly, does not cover VSG... but if I decide it is a better choice for me it is worth the financial sacrifice. I mean, this surgery is for life.

Ack! I just don't know. So much to think about... At least I have it narrowed down to two procedures at this point. It's just such a major decision, I don't want to mess it up.

Thanks for listening to my crazy babble. Just getting to "talk it out" with you guys is very helpful.

[SpookyXXL]

find out if there is anywhere that you could get DS done laparoscopicly, I was in hospital 3 days and up and about and off pain meds in under 10.

I eat eggs with a little (like a tablespoon) of real bacon bits sometimes but only for flavor, I am just as likely to tear up a little lean ham or just add cheese. other than that I dont eat bacon cause I dont like how I feel when I eat fats. I dont eat anything fried at least deep fried and when I fry an egg it is in PAM though I will use a tablespoon of butter to fry up a pan of veggies sometimes and throw in shrimp or chicken.
Also look for NECTAR protein, it is added to water mostly and comes in many juice based flavored, vanilia and chocolate and non flavored, I dont have any problem with it and I did off of Whey Supreme. the thing i like about NECTAR is it is not a body building protein like so many so doesn't have tons of unnessaray stuff in it. it is also sugarfree and fat free

[jillybean720]

I do think life with a DS may be more challenging for you as a vegetarian unless you can commit to shakes or maybe some hard core tofu consumption!

As for the fake meat products, I just want to note that it's not just that they contain more carbs than most DSers "allow themselves," but rather than carbs, even whole grains, cause gas for many DSers (myself included, and I have a WAY longer common channel than any other DSer I've ever encountered). Unfortunately, this is one of those YMMV issues, so you won't know beforehand how carbs may or may not affect you post-op.

Also, on the vitamin front, please be aware that you will also likely have to take vitamins 3-4 times a day with the VSG. The reason for this: calcium. Post-WLS (ALL types since you can't eat enough food to get in all required nutrition even without malabsorption), patients are typically recommended to take in 1200-1800mg supplemental calcium. Since the body can only absorb about 500-600mg calcium at one time, you have to split that up into at least 2-3 separate doses. Then, if you also need to take iron (based on your labs), you have to take that in another separate dose because calcium and iron don't play nice together (unless you take a heme iron, which is more expensive). You can also plan on supplementing with multivitamins and also likely vitamins D and B12 after a VSG.

EDIT: Oh, and on the topic of being a good example of eating for your kids - I plan on raising my children to NOT limit their fat intake but rather to limit their simple carb consumption. More and more studies are showing that high dietary fat is NOT directly linked to increased cardiovascular risk factors unless consumed along with carbs. From a personal standpoint, pre-op, so with completely normal insides, I switched myself to a low-carb, unrestricted fat diet, and my total cholesterol came down (even though it hadn't been high to begin with), my triglycerides came down (which had been pretty high), my glucose came into control (post type 2 diabetes diagnosis), my uric acid came down (had previously been elevated)...I believe the media and even the medical community has made fat an enemy it never should have been made into. (I'll get off my soapbox for that topic now!)

[SpookyXXL]

Originally Posted by jillybean720

EDIT: Oh, and on the topic of being a good example of eating for your kids - I plan on raising my children to NOT limit their fat intake but rather to limit their simple carb consumption. More and more studies are showing that high dietary fat is NOT directly linked to increased cardiovascular risk factors unless consumed along with carbs. From a personal standpoint, pre-op, so with completely normal insides, I switched myself to a low-carb, unrestricted fat diet, and my total cholesterol came down (even though it hadn't been high to begin with), my triglycerides came down (which had been pretty high), my glucose came into control (post type 2 diabetes diagnosis), my uric acid came down (had previously been elevated)...I believe the media and even the medical community has made fat an enemy it never should have been made into. (I'll get off my soapbox for that topic now!)

you know Jilly that makes sence to me, I always went on either Very Low Calorie diets OR very low fat diets before I considered surgery and never lost over 25 pounds which I always gained back plus some. Then my dr put me on South beach which is Low carbs-very mildly restricted fats (as in healthier lean meats and milk fats not fried stuff) and I lost 52 pounds in 8 months.

[Mama]

Great points, jilly...

I admit that as a lifelong dieter, the low fat = healthy idea is deeply entrenched. Look where it has gotten me! LOL! So, yeah, I realize that I may need a nutrition re-education no matter what surgery I choose.

Thank you guys for so generously sharing your thoughts and personal experiences!