Article from the grad board

I visit the grad board from time to time. And I read this article over there and found it to be very informative and interesting. I thought some of you may be interested in what it had to say about Dumping Syndrome. Later, Melissa The Physiology of Dumping Syndrome Dumping syndrome is usually divided into "early" and "late" phases - the two phases have separate physiologic causes and will be described separately. In practical fact, a patient usually experiences a combination of these events and there is no clear-cut division between them. Early dumping is caused by the high osmolarity of simple carbohydrates in the bowel. The various types of sugar all have small molecules, so that a gram of (for example) sucrose has MANY more molecules than a gram of protein, creating a higher concentration (number of molecules per cc) from simple sugars than from other foods. This matters because, inside the body, fluid shifts will generally go toward the higher concentration of molecules. So, if a patient consumes a bite of milk chocolate (lots of sugar), when it gets to the Roux limb it will quickly "suck" a significant amount of fluid into the bowel. This rapid filling of the small bowel causes it to be stretched (which causes cramping pain). This also causes the activation of hormonal and nerve responses that cause the heart to race (palpitations) and cause the individual to become clammy and sweaty. Vomiting or diarrhea may follow as the intestine tries to quickly rid itself of this "irritant." Late dumping has to do with the blood sugar level. The small bowel is very effective in absorbing sugar, so that the rapid absorption of a relatively small amount of sugar can cause the glucose level in the blood to "spike" upward. The pancreas responds to this glucose challenge by "cranking up" its output of insulin. Unfortunately, the sugar that started the whole cycle was such a small amount that it does not sustain the increase in blood glucose, which tends to fall back down at about the time the insulin surge really gets going. These factors combine to produce hypoglycemia (low blood sugar) which causes the individual to feel weak, sleepy, and profoundly fatigued. Late dumping is the mechanism by which sugar intake can create low blood sugar, and it is also a way for gastric bypass patients to get into a vicious cycle of eating. If the patient takes in sugar or a food that is closely related to sugar (simple carbohydrates like rice, pasta, potatoes) they will experience some degree of hypoglycemia in the hour or two after eating. The hypoglycemia stimulates appetite, and it's easy to see where that is going.... The reason that sugar does not cause dumping in non-operated people is that the stomach, pancreas, and liver work together to prepare nutrients (or sugar) before they reach the small intestine for absorption. The stomach serves as a reservoir that releases food downstream only at a controlled rate, avoiding sudden large influxes of sugar that can occur after a Roux-en-Y. The released food is also mixed with stomach acid, bile, and pancreatic juice to control the chemical makeup of the stuff that goes downstream and avoid all the effects outlined above. Obviously, surgeons consider dumping syndrome to be a beneficial effect of gastric bypass - it seems to be important to provide quick and reliable negative feedback for intake of the "wrong" foods. In practice, most patients do NOT experience full-blown dumping more than once or twice. Most simply say that they have "lost their taste" for sweets. Of course, this is always a great topic to ask patients about directly, so you may want to ask about it at our support group in person, or in a support group online.

That is very interesting, thank you for sharing it with us. Rhonda

Now I am trying to figure out which dumping do I have? LOL! Needless to say Sugar is an Evil monster!!!! Cheryl

Sugar is an evil monster. Sometimes I can have a little sugar and seem fine and not dump or so I thought. But I obviously have the late dumping really bad because if I eat sugar or even carbs like crackers or chips I will have a severe low blood sugar reaction a couple of hours later complete with the shakes, dizziness, nausea and a feeling like I am going to pass out. I have learned I just cannot have sugar or simple carbs unless I couple it with lots of protein. And even then I found when I eat just a little sugar or carbs even with the protein I will be comatose and worthless the rest of the day with no energy and just really sleepy. Took me forever to figure out why I was tired. Had to go back and read my food journal and saw the culprit or pattern and had to cut out some bad carbs. And for all of the above I am very thankful because it keeps me away from my terrible weakness or comfort foods most of the time except when PMSing I must have chocolate and other junk LOL. Something about that PMS that makes me want all the stuff that I know will make me feel bad. Human nature is so confusing LOL. Melissa

I learned something!!! I didn't know why the body reacted the way it does to sugars! Thanks for letting me know. smoochies:kiss; Arlies