2008 October: Daily Blog

Re: [CMC-WLS] New file uploaded to CMC-WLS

2008-10-31 20:28:23

I clicked on the link but get nothing......

Re: [CMC-WLS] Recipe File

2008-10-31 19:11:46

That is a great idea Diane, if I come across something I will be sure to post it.

Kim

dyer

7/11/06

324/236/165(goal)

Comments: 6 »

DUMPING SYNDROME DEFINED, EXPLAINED, AND AVOIDABLE!

2008-10-31 12:16:51

I'm looking through my collection of articles today and found this
one on dumping. I don't remember where I originally found it so
unfortunatly I cannot give proper credit. My apologies for that.
DUMPING SYNDROME DEFINED, EXPLAINED, AND AVOIDABLE!
The weight loss that is achieved through the RNY appears to be
primarily dependent upon the removal of the pyloric valve, leaving
the individual without a regulator of food movement into the small
intestine. This results in the well-known phenomena called "dumping
syndrome" which can cause an individual to feel sick or even faint.
It can also cause you to sweat, shake, feel tired, and sleepy.
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. "Early" dumping begins during or
right after a meal. Symptoms of early dumping include nausea,
vomiting, bloating, diarrhea, and shortness of breath.
"Late" dumping happens 1 to 3 hours after eating. Symptoms of late
dumping include weakness, sweating, and dizziness. Many people have
both types.
Stomach surgery is the main cause of dumping syndrome because surgery
may damage the system that controls digestion. Treatment includes
changes in eating habits and medication. People who have dumping
syndrome need to eat several small meals a day that are low in
carbohydrates and should drink liquids between meals, not with them.
It is imperative to the Roux En Y or other procedural gastric bypass
patient that they follow their diet plan to reduce the risk factor of
Dumping Syndrome. Many people equate the term solely to be spasmodic
fits of diarrhea, when that is merely one of the symptoms of a more
intensified unpleasant experience. Dumping syndrome is usually
divided into "early" and "late" phases - the two phases have separate
physiologic causes and shall 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.
It is an unpleasant side effect of this surgical procedure,
experiencing it means one simple thing; you are not following your
prescribed diet, and unless you do, dumping syndrome is going to
become a major part of your life.
Do yourself, and your body a favor and follow the doctor's orders, to
the letter.

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