Everything you wanted to know about dumping...

The below is written by DX...As many of you oldtimers know he was a very wise man...you can see by his post.  He doesn't come on these boards much anymore, but for me, as a new post op, his posts were priceless.  I've often thought he should make a CD of his posts and sell them.  He has hundreds of posts like these...Brian

DUMPING SYNDROME DEFINED,
EXPLAINED,
AND AVOIDABLE!

Ok arkman asked for a description
Of Dumping and here goes-

It's a combo of What I've been told,
What I've experienced and
Some of the Med-Speak Crap
and some from handouts from my Doc. At Support group.

(Remember, If you opt for DS or the Band
No dumping "per sea," But, often
Some lactose intolerance and minor 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
(see "Foamies" in another thread.) As the only regulator
Of food movement into the small intestine.
This results in the phenomena called "Dumping Syndrome."
It can cause an individual to feel sick or even faint.
And by "sick," I mean anything 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 duodenum or the jejunum moments 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 lower end of the small intestine (jejunum)
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 mild to Frightening)
And shortness of breath.

It is caused by -
"the high osmolarity of simple carbohydrates 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 will 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 a wave of hypoglycemia.
That requires some bravery and stupidity
In just the right balance, but does happen.
That "Emotional Eating," Thing is a doozey!

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 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 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 their 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% mal-absorption of Fats in RNY people
And the 81% mal-absorption of Fats in DS people.
In Both, the extra unabsorbed fats 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 down to keep
The Poo Normal. Yes?

Sugar Alcohol is another confusion in the mix...
Sugar Alcohols have a Laxative effect and can cause cramping
and bloating for anyone, WlS post-o*****n-Op,
even when eaten in moderate doses.
This cramping / diarrhea effect of one bite too much of
a Sugar Alcohol would happen even without the surgery,
But since many Post-Ops are seeking out more SF alternatives,
They end up being the folks who "test out" more Sugar-Alcohols.
(so not Dumping, just the Laxative property of Sugar Alcohol...)
 
Many, (me included)
Consider dumping syndrome
To be a beneficial effect of gastric bypass.
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 me, have it for life.

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."

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 

Wow ...that's the best explanation EVER !!! 

DX was/is a college professor at a major university.  About 11 years ago he had RNY...And had complication.  The surgery was pretty new at that time.  He spent about 6 months in the hospital...So he read and read and read everything he could get his hands on concerning WLS and the RNY...You see the results!!

Have you had complications. I had the band out in February. I'm still deciding about sleeve vs rny. What's your input being a ten year rny ER.  Thanks 

Steven...I'll private message you.  People roam these boards and look for the littlest things to disagree with.  I'll send you some general guidelines.  Brian

Very informative. Thanks for sharing! 

This was very good.  

A few comments: - some "normies" can have early dumping syndrom from too many sugars. 

Late dumping - also known as RH - reactive hypoglycemia , can happen to others as well. 

It is known that if a person is following a very low carb diet for a while - then east a lot  simple or even complex carbs in one sitting (i.e and regular ice cream) they may get the RH. 

For us, RNY, study showed our body makes 10 -20 x more insulin in response to carbs. 

When I follow a very strict low carb diet forb2-3 weeks, then get some carbs ..(ie popcorn, or bread, or enev fruits) I would get severe RH.  But if I am more relaxed with my eating - and eat more fruits, starchy veggies, etc... I may not get RH, because I have food glycogen level in my body. So as my BS drops - my body uses that to bring it back...

During low carb time - my body uses all available glycogen and is buring fat. So when I introduce some carbs my body overreacts and there is not "stored sugar(- glycogen) to regulate my BS even when my body is trying to do that. 

Good info Hala,

I have RH even now as a "normie" ****il Monday anyway)

I get hypogylcemia if I don't eat right or if I don't eat enough sometimes.

I was wondering if after surgery, it would get worse for me since I suffer it as a normie.

Oh may try to see a good endocrinologist.  

Hypoglycemia can be a sign for insulinoma, or cortisol deficiencies - Adrenal Insufficiency.  

I had that post op RNY and detailed tests show that I had mild secondary andrenal insuficirncy togetherness with insulin resistance. 

Anderal hormons control BS, BP and mineral balance... 

I have a great doc in Greenville SC, but she does not take new patients.  My friend is going to another (hopefully also very good) doc... 

My hypoglycemia and RH were out of control app 3-4 years ago. It is getting better..

I can't believe I missed that you had your surgery with Dr. Bour. Or if I saw it, I forgot lol. I was talking to someone else about theirs with him the other day in the comments of someone else's post lol. Nice to know a few SC folks on here! 

I have PCOS, which is believed to be caused by insulin resistance. But the funny thing is, besides gestational diabetes with my first pregnancy, I've never had a problem with high blood sugar. Its weird to me that my sugar runs in the high 80s to low 90s at this weight with PCOS! My A1C is perfect and has always been. Plus I check my sugar just  to make sure I'm not developing any changes. 

Something even funnier. Diabetes type 2 runs in my family on my father's side, and my mother has type 1 juvenile diabetes. 

I just consider myself very lucky to have gotten this far without it catching up to me...