Dumping 101....(old post drug out again....)

Ok, On ‘The Main Board’ I often see such phrases- “I Dump from Protein! Help” or- “My Vitamins Cause me to Dump!” - or- Foamy spit in the back of my throat—That’s Dumping!”  - even -  “My hair is getting thin, Is this Dumping?” ……………… (most recently, just a simple- “What is Duping?”) For newer guys here, or those gals often lurking by- Dumping …..here goes- (yes, it just applies to those with RNY’s but hopefully useful for them) (and same blah, blah, blah…skip if you aren’t interested…) “Everything you Ever/Never Wanted to Know About Dumping!” (& some) It’s a combo of What I’ve been told, What I’ve experienced and Some of the Med-Speak Crap From handouts from my Doc. At Support group. (Remember, If you’ve opted for DS or the Band No dumping “per sea,” But, often Some lactose intolerance and minor late stage-dumping Even with the DS.) The weight loss that is achieved through the RNY Appears to be greatly dependent On the removal of the Pyloric Valve, (the “sphincter” of the stomach) Leaving the individual with a small stoma - As the only regulator Of food movement into the small intestine. This can result in the phenomena called "Dumping Syndrome." It can cause an individual to feel sick or even faint. And by “sick,” I mean any thing from –  “I feel a little icky…” – to - “Please God, Let Me Die!!!” Although many think the name would come from  “Taking a Dump” just with the Volume turned WAY UP! The Slang term actually comes from the way food is “dumped” Into the small intestine 10 to 15 minutes after eating, Rather than being released gradually in small amounts By the Pyloric Valve from the stomach into the small bowel. This Rapid gastric emptying, or dumping syndrome, Happens when the small intestine (jejunum portion) Fills too quickly with undigested food from the stomach. Now this is the part That leads to so much confusion- There is –  “Early Dumping” And “Late Stage Dumping” They are rather different. And caused by different things. "Early" dumping begins during Or right after a meal. Symptoms of early dumping may include – Nausea, Vomiting, (resulting from that nausea) Bloating, (Fast Gas Production) And Diarrhea, (ranging from Normal to Freakishly Explosive!) And shortness of breath. It is caused by –  “the high osmolarity of simple carbohydrates or fats in the bowel.” * Brain running in back room to look for Biology Text Book * Remember “Osmosis”? That Permeable Membrane stuff? Osmolarity is the “Come Hither” quality of osmosis. Things with High Osmolarity have a lot of molecules and  “Suck” water To themselves. 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 From simple sugars than from other foods. They “Suck” More Water. Still follow? This matters because, inside the body, Fluid shifts will generally go Toward The higher concentration of molecules. So, a bite of milk chocolate (lots of sugar), When it gets to the Roux limb it will quickly "suck" A lot of fluid into the bowel. This rapid filling of the small bowel causes it to be stretched  (Which causes cramping pain). With fluid from all throughout your body, Rushing to “The Party in your Intestines,” Blood pressure can drop, you can feel suddenly In the full blown effects of dehydration, etc… I feel warm all over very quickly Like I’ve had a Big Double shot of Brandy. Flush face and cheeks and hot inside. This also “Can Cause” The activation of hormonal (depending on the person) And nerve responses That cause the heart to race (palpitations) And “Can Cause” The individual to become clammy and sweaty. Vomiting or diarrhea may follow  (Diarrhea is most common) As the intestine tries to Quickly rid itself of this "irritant. " The same sort of reaction That you would have to Food Poisoning!  “Everybody OUT!!” You typically have between 5 and 15 Minutes before It hits. Later than that, could just be plain Ole Runs. This Diarrhea “Can” Range from-  “Wow, I’ve really got to Go!” To- Rip the porcelain off the Bowl, Explosive, “This is like ‘From the Exorcist’ Crapping!!!” That best describes Mine. Well, actually coupled with Late as well. Some people have both types to a degree. I’m lucky that way…. "Late Stage Dumping” Happens 1 to 3 hours After eating. Symptoms of late dumping include weakness, Sweating, and dizziness. 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. Yes? So you feel like Someone has given you an unnecessary Shot of insulin. It’s basically a bout of hypoglycemia (low blood sugar), Which causes you to feel weak, Super Sleepy, and completely fatigued. Late Dumping has another Evil in its arsenal. It is a way for gastric bypass patients To Fall 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 may experience a small degree of Hypoglycemia In the hour or two after eating. The hypoglycemia stimulates appetite, You eat more, cycle repeats,….. And it's easy to see where that is going.... Yes? Some, who claim “bingeing” with Carbs Have actually been riding like a surfer On the front edge of a wave of hypoglycemia. That requires some bravery and stupidity In just the right balance, but does happen. That “Emotional Eating,” Thing is a dozey! 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, through the Pyloric Valve. This avoids the sudden large influxes of sugar That can occur after a RNY. 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 of these effects above. For Late Dumping – Lying down immediately after eating reduces the symptoms Because gravity isn’t draining the stuff straight into Your intestines. Yes? It may give you just a serious nap. Now, One more Intricacy that makes it so Difficult to pin down –  “Dumping Syndrome-Do I have it or Not?” Is- Lactose Intolerance. The symptoms of this are typically Gas, medium to extreme, Diarrhea, medium to extreme, And most all of the symptoms of dumping syndrome Except the Blood Sugar drop Seen in Late Dumping. Since Bypassing some of the small intestine, (That portion where typically the milk sugar Lactose Would be processed,) The milk sugars may also create small Amounts of Dumping syndrome on there own. Many Bypass patients who do not have the big reaction to Sugar in the form of Dumping Syndrome will Experience the typical Lactose intolerance symptoms That some Non- Bypass people have. The Lactose in milk, has been eaten or processed By bacteria mostly in Yogurts, and Cheeses Which is why those don’t cause problems. Some will also have Dumping-Like Symptoms resulting from Foods with high fat content. More like severe indigestion with diarrhea rather Than full out Dumping. This is due to not mixing with bile Soon enough in the system. This is one of the reasons For the 38% malabsorption of Fats in RNY people And the 81% malabsorption of Fats in DS people. In Both, the extra unabsorbed fats, (If in high enough concentration,) Tend to cause them to Poop like a Goose! So for both, particularly The RNY folks who still get calories from a lot of that fat, Best To keep those fat percentages under control to keep The Poo Normal. Yes? Many, myself included, Consider dumping syndrome To be a beneficial effect of gastric bypass. Freaky at that seems to some, It provides 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. Some, have Dumping Syndrome early on, But as their system adapts to the new  “Goings On,” they lose it, And their Digestive system compensates. Others, like myself, have it for life.  (or at least it’s still going strong at nearly year 3) There are some people who have had no reaction To sugars and then One Day- POW! Full Blown Dump! Something about the food they ate, And the speed that in went into The intestines, set them off. This happens sometimes Due to drinking with a high osmolarity food. Speed into the Intestine Plus Molecular Density Of the thing entering, Equals “Degree of Dumping Syndrome Effect.” Yes? Now, All that sounds bad. But, It can all be avoided- JUST Don’t Eat Sweets! And High Carb/Sweet mix foods! Or- The General Guidelines For avoiding/reducing Dumping Syndrome (From a handout at my support group From a Nutritionist who works with Bypass folk.) 1.) Avoid taking liquids with meals. Liquids should be taken 30 minutes before or after meals And limited to ½ to 1 cup servings. Carbonated beverages are not recommended In the initial stages of the diet to prevent excess gas formation. 2.) Small, frequent feeding should be provided. The number of feedings depends on the patient’s tolerance To specific portions of food. Foods should be eaten slowly and chewed well. Avoid those known to cause individual problems. 3.) The diet should be low in simple carbohydrates, High in complex carbohydrates and protein, And moderate in fat With the purpose of achieving and maintaining The optimal weight and nutritional status of the patient. 4.) All food and drink should be moderate in temperature. Some patients tolerate warm water Better than iced or cold water. 5.) Avoid foods that are natural laxatives, Such as figs, prunes, and licorice. 6.) If “dumping” is a problem, It may be helpful to lie down 20 to 30 minutes after meals and even up to an hour To retard transit to the small bowel. 7.) Slowly introduce small amounts of milk into the diet To determine tolerance. If milk products are tolerated, They can play a key role In providing an easily tolerated protein And other nutrients such as calcium and vitamin D. Trick/Tip from my Doc- (useful for Diabetics as well) Pectin, A dietary fiber found in fruits and vegetables, May be helpful for treating dumping syndrome And even simple diarrhea. Pectin delays gastric emptying, Slows carbohydrate absorption, And reduces the glycemic response. 1 tsp pectin powder 3 times daily may be effective.  (It’s that “Sure-Jell” stuff for making Home-made Jelly. Great food additive) So, That’s the –  “Everything and then some I know about Dumping.” Best Wishes- Dx

 

That was great!  I am somewhat anal in that I love to read and research everything I can find on any subject I am interested in.  Since starting the WLS process I have heard this term and vaguely understood the meaning.  Maybe next time you can read us nice bedtime story about proper chewing and how to avoid getting a nice piece of meat lodged in your gut somewhere?   I guess you might also be the person to ask this question... I understand that the surgery involves tinkering with the intestines, what kind of precautions do they take when preparing for surgery?  I am referring to "cleaning the pipes".  One aspect I am not looking forward to is the catheter, but an enema would be a close second.  Would you recommend doing some type of colon cleanse prior to surgery?  I am thinking of it for a couple of different reasons.  Mainly, since stomach will be "new" might as well start with a fresh set of exhaust headers, and I thought it may help with a few pounds of a pre-op diet plan. What do you think?  good idea or no? Again, Thanks for the info, I look forward to your next post.

Pre-Op Bowel Prep is different depending on the particular surgeon’s protocol. Typically, Most surgeons have their patients begin final phase of bowel preparation one day prior to surgery. The bowel preparation generally involves two parts. The first is a brief restriction of the diet to liquids, which 9depending on the doc) Can be 2 days to 2 weeks of liquid diet only. The day before surgery, MOST surgeons have their patients take some form of oral laxative. I’ve seen people mention a huge range of laxitives But the most common laxative solutions, are-  "Go Lightly" or "New Lightly," that require drinking a lot of a liquid, Or more concentrated laxatives such as "Phosphosoda" or "Magnesium Citrate." All of them Eqal “Colon Blow!” An actual enema is used by fewer surgeons, And many of them that do use an enema as part of the process Do so after the patient is anesthetized. Having a typical Fleet enema or the old school hose and bag of water Is not at all “the norm.” In fact, the exception. Some docs will put their patients on an oral antibiotic a week prior to surgery To further reduce the overall level of bacteria in the digestive tract, But that also is the exception not “the norm.” Find out what YOUR doc does as a standard procedure, and if it seems odd, (or even not) ask “Why?” They are pretty good about explaining their preferences. The catheter and the enema? No worries.  You may mis out on all or most of that “Fun.” (I do have a couple of other “Before heading off to surgery…” Posts, I’ll dig ‘em out for you…) Best Wishes- Dx

 

I would appreciate anything you have. Paul

DX, Thanks for the repost, I am going to have my wife read this. I am not sure I have ever been able to explain to her exactly what or how "dumping" happens. Troy

Dx,

On behalf of the many lurkers and newbies here (such as myself), I want to give a big thank you to you for all of your many informative posts.  Keep them coming, they are much appreciated! 

MLF

Dx,

Wondering if you've ever heard of someone who started to dump from going on low-carb? Now, whne I eat carbs, I either get really hot and start to sweat or really sleepy or both.

It's almost as if low-carb made me hypersensitive to carbs!

Dave

Dave, No info on that front… Then again, “sensitizing” your system seems possible, Particularly in your case. Your modified diet to ‘over-ride’ typical metabolic tendencies coupled with the edited guts from the RNY Which already ‘over-ride’ typical metabolic tendencies, could certainly give rise to some aberrations. OR- you are having some commonplace Late-Stage Dumping That many RNY’ers experience. Dunno. Sort of like the use of Vulcan technology by federation engineers To power a Romulan  Cloaking device…. (Ok, not really a Trekkie, but the only analogy I could think of late at night…) My guess is that it’s typical Late-stage dumping. When I eat many High-Glycemic Carbs, like bread or pasta, I get sleepy, and CAN get the sweats as well. I just don’t eat them very often at all… Mostly Lower-Glycemic Carbs like Beans and Tomatoes and such… Hope all is going well for you and that you are reaping all of the benefits of your new-found fitness and advanced techniques… Best Wishes- Dx

Thanks, Dx!

Could be late-stage dumping, like you say.

I get no nausea, cramps or diahrrea. Wonder what causes the hotness and sweating?

Best Wishes,

Dave

Dave, I’d think it was a Blood Sugar spike, then sudden drop from the Simple Carbs causing your metabolism to boost your insulin production and then not having a steady stream of available Nutrients. (like you would have from a lower-Glycemic Carb supply. Sort of the RNY’s way of hitting you with a mild temporary case of hypoglycemia. The classic symptoms of Low-Blood Sugar are- Shaking, Sweating, increased Heart Rate, (even ‘pounding Heart sensation) Which could account for the “Hot Flushed feeling,” pale, clammy skin, dizziness, yawning, and sleepiness/ energy drop. The typical recommendation to combat a mild hypoglycemic episode, is to eat something that isn’t high-Glycemic Carbs as soon as possible. Whenever I have a case of “Late-Stage Dumping,” (same symptoms you mention plus the shakiness) I eat some cheese and maybe some beans and get in some extra water and I’m back to normal fairly quickly. Best Wishes- Dx