So, DS Isn't Magic After All.

Lots of non-ops have heard of the Lap Band and the roux-en-y gastric bypass, but there are many other weight loss surgeries out there. I intially wanted the biliopancreatic diversion with duodenal switch ("DS"), but it wasn't available to me. I wanted the DS simply because studies show that it presents the least likelihood of regain, and because I thought I would be able to volume eat with no repercussions. The DS is the most malabsorptive of the regularly-performed WLS options, permitting the body to absorb only 20% of fat intake. In comparison, the band is purely restrictive, while the RNY is both restrictive and malabsorptive. DS is somewhat less restrictive and more malabsorptive than the RNY.

I had the RNY because it was the most malabsorptive option available to me at the time. That was it. It wasn't because I'd heard RNY was the "gold standard"; it wasn't because I was afraid of the risks or alleged DS side effects. RNY was my choice because I was morbidly obese, my insurance covered RNY, and I was going to take what I could get at the time instead of waiting around and getting even fatter.

I've been thrilled with my RNY so far, but in the back of my mind I still coveted the DS. I worry a lot about stretching my stoma (the surgeon-created opening between the reconfigured tummy and the small intestine.) There are revision procedures to address this problem (e.g., Stomaphyx; band over bypass; the ROSE procedure), but I've heard they don't work that well in the long term. On the other hand, the DS leaves the pyloric valve (valve between a normal stomach and the small intestine that regulates the rate of food emptying) intact, so there's no need to worry about stretching the stoma.

However, I'm most envious of DSers when I'm having a rough go with the scale. I say to myself - and often to others - "Well, if this doesn't work, I'm getting the DS!" I thought that with the DS, it wouldn't matter what I ate because I wouldn't absorb half of it. There's no way I'd regain, no matter what!

Guess what: I was wrong. People with DS can regain too. It may be statistically less likely, but it is nonetheless possible if you break the DS rules.

Over the past couple days I've taken a few looks at the DS message board on ObesityHelp.com. Why? Because, even though I've had the RNY, I've still thought of DS as a future option. I'm a DS fan and wanted to stay up on the info.

I learned three amazing things from lurking on the DS board:

1: Given my particular food demons and preferences, RNY probably would have been the right call for me even if DS had been available.

I was vegetarian for nearly 6 years, and I'm considering going back to it someday. If I had the DS, that would be extremely difficult if not impossible - the DS diet is even lower carb than the RNY. I'd say DS is to Atkins as RNY is to South Beach, maybe? No, not all DSers remain low-carb for life, but some say that more than a couple bites of white flour gives them the runs all day. Yes, there are similar RNY horror stories usually pertaining to meat, but I'd rather get sick from meat than bread. And fortunately, I can tolerate meat really well. Yes, you can eat more with DS than with RNY, but you still can't eat a lot. And the foods are allowed in large volume, like fats and meats, are the foods I'm least likely to binge on. I've never been a big fatty food lover. Greasy food has always kinda grossed me out (and I was exposed to a LOT growing up in the South and spending a lot of time with my grandparents.) I'd always choose the lowfat option; I'd just eat an ungodly amount of it. Getting to eat unlimited regular bacon doesn't excite me at all.

2: DSers have weight-loss stalls too.

Maybe it was dumb for me not to realize this. But I sincerely believed that if I'd had DS, the weight would roll right off even faster than it has with the RNY. Now, having read the DS board and seen the posts about stalls that are just like the ones on the RNY board, I'm not sure that's true.

3: As with any other WLS, DSers can regain if they don't follow the DS dietary rules.

For some reason, I thought DSers were exempt from most dietary restrictions. I probably got this impression from DSers themselves. Because DSers feel oppressed and discriminated against in the WLS community, they try not to air their dirty laundry publicly. DSers are usually cheerleaders for their surgery on the message boards, which is understandable because there is a lot of misinformation and unwarranted DS-hate out there.

However, when you visit the (D)ark (S)ide, as some of them call it, you see that, much like RNY, weight loss and maintenance are no longer effortless after the first year or so. I just read a post in which a person a few years out shared that she had seventy more pounds to lose because she's allowed empty carbs like rice, pasta, bread, and regular Coke back into her life. I read several posts in which a people admitted to regain after DS (no, they didn't regain all of their weight, but more than the standard bounceback of 10-15 pounds.) What was fascinating, particularly about the first post, is that several DSers chimed in with comments like, "There is no WLS that exists that is a free ride," and "Those simple and forever rules apply to all WLS," and "Compliance is key," and "Some folks may have to diet."

Whaaaa??? I've read comments from DSers on other boards where they talk about the joy of eating cookies, drinking while eating, and never dieting while still maintaining their goal weight. But it turns out that DSers have known the truth all along: No surgery will allow you to eat cookies all the time and get to/stay at goal. There really is no magical solution to morbid obesity. No matter what surgery type we have, those of us who struggle with this will be fighting it for the rest of our lives. Yes, some surgeries make the process easier than others. DS has the most malabsorption, so the theory is that even if you screw up every now and again, it will just come out the other end (to put it indelicately.) But even with all of that malabsorption, you still have to follow the rules most of the time to be a long-term success.

Perhaps all of this was obvious. It was naive of me to buy into the DS hype, and had I taken a look at dsfacts.com's weight regain section, I would have known this already. I will admit that I didn't thoroughly research the DS, mostly because I found out early on that it wasn't going to be an immediate option.

In any event, my grass-is-greener perspective on the DS is a thing of the past. DS is wonderful, but so is RNY, and just like RNY, it takes work. My covetousness of DS was keeping me from fully appreciating my own surgery. I realize now that RNY was not just the best option available to me - it was the best option for me, period.