Dumping syndrome

November 24, 2002

I own a yahoo group called Men-Of-WLS, in that group someone was nice enough to

post the below about Dumping syndrome in the files section. Hope this is helpful

to some of you that have had questions about dumping. And no, I'm not tryin' to

promote my group..LOL....

DUMPING SYNDROME

DEFINED, EXPLAINED, AND AVOIDABLE!

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 doctors orders, to the letter.

Thanks tbearsrus......

Randy Ogle

rlogle@...

www.geocities.com/rogle32/

AIM: rlogleeln

Open RNY: Sept. 26, 2001: 204 lbs gone.

Daddy to Doogun, Jasper, and Zoe.

Lord, Please help me to become the Person

my Dog's think I am.

November 24, 2002

In a message dated 11/25/2002 7:31:56 AM Eastern Standard Time,

beaglette@... writes:

> eating in moderation, the foods I want

, I agree as long as you are getting proper nutrition. If all you want

to eat is pasta, you can stay thin but dead. I eat what I want with an eye

to protein first. Fay Bayuk

November 25, 2002

, My surgeon and nutritionist insists that if it doesn't taste good,

you will fail. We use real buuter, mayonnaise salad dressing, as long as we

get our protein first. Fay Bayuk

November 25, 2002

In a message dated 11/25/2002 6:36:14 AM Pacific Standard Time,

beaglette@... writes:

> I know that some may have to " diet " to reach their numeric goals but then

> that also perplexes me. ..... I agree that one must change their behaviors

> towards their food ... However, I've found the balance for my food-life

> where I don't eliminate those foods (milkfat) from my life but rather

> incorporate them, in moderation.

>

For me, words like " balance " and " change your behavior " have absolutely no

difference in meaning than " diet " or " modified food plan. " I think it's an

issue of semantics. Is it easier to do now that I'm smaller to begin with?

Yes, it is but for psychological reasons. A 5 lb. weight loss produces a

visible result; when you want to lose 20 lbs. vs. 120, the effort does not

seem quite so hopeless, and the motiviation is stronger. Is it easier to go

to the gym and work out at 140 lbs. than it was at 260? You bet it is!!

(But I still hate every moment of it!)

Kate

November 25, 2002

I like the pure taste of things. Even when I was younger, I would not eat a

sunday because it obscured the taste of the Ice Cream and I love ice cream.

I eat plain popcorn for the same reason, butter messes with the flavor. As

much as I like the taste of chicken, I have to have a simple gravy, because

it is too dry without it and I wind up stuck. I love the crust of various

breads, French, Italian etc., so that is what I eat, a small piece will do.

I am one of the lucky people, I really do not crave sweets. That said, I am

a potato chip abuser, so I cannot eat it at home, but I can eat a few out.

You get my drift. Fay Bayuk

November 25, 2002

In a message dated 11/25/2002 9:35:55 AM Eastern Standard Time,

beaglette@... writes:

<< Thanks for your response! It's refreshing to hear someone who approaches

this like I do. It seems I hear a lot of talk about " dieting " after weight

loss surgery. I'm just perplexed. I know that some may have to " diet " to

reach their numeric goals but then that also perplexes me. Why does dieting

work now yet it never worked before? Yes, twice in the past two years I have

cut my carbs to get my weight loss started up again but it was never a

continual thing. I did Atkins induction for a week, got the scale moving and

went on as before and the numbers kept moving down. >>

, if this works for you, live it and enjoy. But don't get down on the

folks who may not be as lucky. Pre surgery I did not realize that I was

going to be on a diet the rest of my life, but 15 months later I know it now.

As your original post indicated, each person has to what works for them.

B

November 25, 2002

I know that I've not really introduced myself and I hope that post is

forthcoming today.

Thanks for this dumping syndrome " article " , Randy.

I just gave a cursory read to it but the one thing that caught my attention is

this line:

" It [dumping] is an unpleasant side effect of this surgical procedure,

experiencing it means one simple thing; you are not following your prescribed

diet... "

I disagree with this. Firstly, your " prescribed diet " is whatever works for

you. Secondly, I have dumped on things that you would never think one would

dump on that one would consider " allowable " .

I have big issues with " prescribed diets " and weight loss surgery. I believe

everyone should do what works for them. I often times see people write a post

and say " are we ALLOWED to have such and such? " WHAT? Firstly, I'm allowed to

have whatever I want to eat, even if that means I pay the consequences for it.

Secondly, I dieted myself up to 480 lbs., why on earth do I think that

deprivation of a certain group of foods is going to work this time? After all,

with my surgery merely changed my body composition, not my brain. I'm a big

believer in getting to the root of the problem, i.e. THE ADDICTION, and using

the tool for help in moderation of one's intake and one's behaviors.

I'm 2 years post-op. On the day of my surgery, I weighed 459 lbs. Today I

weigh 198 lbs. My road hasn't been easy, by any stretch of the imagination

(mostly due to plastic surgery complications) but I'd do it all again in a

heartbeat. I eat what I want (with the exception of a lot of milkfat), when I

want IN MODERATION. I put on a few pounds when I was drinking heavily (that

story is on my website) and have lost about 30 since August 2002, just by doing

what I have always done, eating in moderation, the foods I want.

WLS is about finding what works for you. It's a tool that everyone utilizes

differently and that everyone must work out for themselves.

Warmly,

www.brandiland.com

<<

>>

November 25, 2002

<

>

Fay,

Thanks for your response! It's refreshing to hear someone who approaches this

like I do. It seems I hear a lot of talk about " dieting " after weight loss

surgery. I'm just perplexed. I know that some may have to " diet " to reach

their numeric goals but then that also perplexes me. Why does dieting work now

yet it never worked before? Yes, twice in the past two years I have cut my

carbs to get my weight loss started up again but it was never a continual thing.

I did Atkins induction for a week, got the scale moving and went on as before

and the numbers kept moving down.

Last night there was a special on the Discover channel regarding obesity. There

was a lady who had WLS (I didn't catch which one she had) and she had gained her

weight back plus more (I believe) because she didn't utilize her tool properly

(meaning she ate more than " in moderation " ). It seems from what she said that

she believed the WLS was going to be a panacea for her weight issues.

Obviously, that's not the case. However, she did say something that I've said

all along which was something akin to " After surgery, people talk about 'eating

the right foods' and walking everyday. If it were that easy, why didn't I just

do that to begin with instead of having the surgery? " That makes a WHOLE lot of

sense to me. I agree that one must change their behaviors towards their food

however, pure elimination or deprivation of certain foods or groups of food

scares me a whole lot. I remember before surgery when I did strict low-carbing.

Man, I craved that which I COULD NOT have-- carbs. Low-fat was the same way; I

craved high fat foods when doing the low-fat thing. It puzzles me how some can

elminate certain things from their diet now when before they couldn't. A lot of

milkfat (cream, whole milk, ice cream, copious amounts of butter) is no longer

part of my eating habits because it makes me wish I was dead after consuming

more than 4 bites of ice cream However, I've found the balance for my

food-life where I don't eliminate those foods (milkfat) from my life but rather

incorporate them, in moderation.

Moderation is the key, it seems. Not elimination.

Warmly,

www.brandiland.com

November 25, 2002

>>>insists that if it doesn't taste good, you will fail. We use real

butter, mayonnaise salad dressing, as long as we get our protein first. Fay

Bayuk<<<

*** I agree BUT have acquired some " new " tastes as well in better " choices "

of food like sugar free whole wheat bread for a slice of toast -- but, it is

an acquired taste -- many of us, at one point went from regular soda to

diet soda which is also an " acquired " taste (for me it was....) so... don't

leave off the " acquiring a taste for it " choices...

I think to pick what's important (food wise) and acquire a taste for the

less important things... at least I'm following that trend and doing good

with it so far... still experimenting ~smile~

hugz,

~denise

November 25, 2002

For me, " balance " and " change your behavior " are merely not synonyms for " diet "

or " modified food plan " . I've noticed that when people speak of their " diet "

they generally are speaking of elimination of a certain type of food from their

eating-- that's a diet, not a balance. I would say that balance is a synonym

for moderation (in this example) but certainly not " diet " . Changing your

behavior simply means to get to the root of why you were 480 lbs to begin with

(I'm talking to myself here!). It involves approaching food from a " normal "

person's vantage point instead of an obese persons vantage point.

I meant to add earlier when responding to Fay that I should be a bit more

diligent in my protein. I've been fortunate in that my labs have come back

great the past two years (with the exception of one time-- my albumin was just a

*tad* low-- that didn't surprise me seeing I was so sick I was unable to eat--

ha!)

Warmly,

www.brandiland.com

<

>

Kate

November 25, 2002

, I so totally agree with you. I also have realized that my tastes

have changed since surgery. I think that is because I actually take the

time to chew the food so I can actually taste it now instead of just

inhaling it. There are things that I just don't enjoy anymore. Of

course, there are other things that I do enjoy just as much. I am truly

having to learn to keep somethings out of my house like chocolate,

sweets, chips, etc. I do not necessarily deprive myself of these things,

but I definitely have to work to get it. I have to decided if it is

worth a trip to the store. Sometimes it is. Sometimes it's not.

Lori Owen - Denton, Texas

CHF 4/14/01 479 lbs.

SRVG 7/16/01 401 lbs.

Current Weight 302 lbs.

Dr. Ritter/Dr. Bryce

On Mon, 25 Nov 2002 09:59:44 -0500 " " beaglette@...>

writes:

> For me, " balance " and " change your behavior " are merely not synonyms

> for " diet " or " modified food plan " . I've noticed that when people

> speak of their " diet " they generally are speaking of elimination of

> a certain type of food from their eating-- that's a diet, not a

> balance. I would say that balance is a synonym for moderation (in

> this example) but certainly not " diet " . Changing your behavior

> simply means to get to the root of why you were 480 lbs to begin

> with (I'm talking to myself here!). It involves approaching food

> from a " normal " person's vantage point instead of an obese persons

> vantage point.

>

> I meant to add earlier when responding to Fay that I should be a bit

> more diligent in my protein. I've been fortunate in that my labs

> have come back great the past two years (with the exception of one

> time-- my albumin was just a *tad* low-- that didn't surprise me

> seeing I was so sick I was unable to eat-- ha!)

>

> Warmly,

>

> www.brandiland.com

>

> <

absolutely no

> difference in meaning than " diet " or " modified food plan. " I think

> it's an

> issue of semantics. Is it easier to do now that I'm smaller to

> begin with?

> Yes, it is but for psychological reasons. A 5 lb. weight loss

> produces a

> visible result; when you want to lose 20 lbs. vs. 120, the effort

> does not

> seem quite so hopeless, and the motiviation is stronger. Is it

> easier to go

> to the gym and work out at 140 lbs. than it was at 260? You bet it

> is!!

> (But I still hate every moment of it!)>>

>

> Kate

>

November 25, 2002

, I didn't mean to " get down on folks who may not be as lucky " . I've

always said that whatever works for you, do it. I find it funny when people are

on a diet ( " normal " or " fat " ) and they say " well I'm not allowed to have such

and such on this diet. " What? You are allowed to have whatever you want, even

if it doesn't work for you. But, specifically, what I find funny is the fact

they have no idea what works for them and what does not. When I was MO, I found

that when I gave up dieting was when I finally leveled out my weight. Granted,

that weight was 480 lbs at my highest however, I leveled out and didn't gain any

more.

Warmly,

www.brandiland.com

<

>

November 25, 2002

.. Why does dieting work now yet it never worked before?

1) Malabsorption

2) " forced " limited quantities

3) DUMPING

4) Better educated

5) Hormones that cut off the " feast/famine " signals

6) Change of tastebuds

7) Vomiting

8) More incentive to " maintain " a weight versus " get to " (for me personally

anyway)

Re: Dumping syndrome

> <

> , I agree as long as you are getting proper nutrition. If all you

want

> to eat is pasta, you can stay thin but dead. I eat what I want with an

eye

> to protein first. Fay Bayuk>>

>

> Fay,

> www.brandiland.com

>

November 25, 2002

I subscribe a great deal to your thinking. But my term allowed (once the

doc's, now mine) is what I am allowed to have that does not interfere with

where I'm going.

There is the goal (be it wt, size, comorbs I want back, how I feel), and

there is the road to get to it. If I take detours, I don't get there (or

stay on the road). If I detour, I get taken somewhere I don't wanna be.

So, the term " allow " 'for me, is more of a positive slant. These things

(foods, activities, avoidances) ALLOW me to continue in my desired path.

Anything else INTERFERES with my desired path.

It's all in semantics. I also cannot live a life of negatives & hand slaps.

However, I respond very well to wearing last year's jeans and having a slim

peek in the mirror.

BUT that sentence also reminded me that dumping is not always a result of

our action, in the case of reactive hypoglycemia. Although the RH is much

more violent and sudden than true dumping, the concept is the same. Believe

me, if we knew what caused that, we would most definitely NOT do it! LOL!

Thanks,

Vitalady T

www.vitalady.com

If you are interested in PayPal, please click here:

https://secure.paypal.com/affil/pal=vitalady%40bigfoot.com

Re: Dumping syndrome

> I know that I've not really introduced myself and I hope that post is

forthcoming today.

>

> Thanks for this dumping syndrome " article " , Randy.

>

> I just gave a cursory read to it but the one thing that caught my

attention is this line:

>

> " It [dumping] is an unpleasant side effect of this surgical procedure,

experiencing it means one simple thing; you are not following your

prescribed diet... "

>

> I disagree with this. Firstly, your " prescribed diet " is whatever works

for you. Secondly, I have dumped on things that you would never think one

would dump on that one would consider " allowable " .

>

> I have big issues with " prescribed diets " and weight loss surgery. I

believe everyone should do what works for them. I often times see people

write a post and say " are we ALLOWED to have such and such? " WHAT?

Firstly, I'm allowed to have whatever I want to eat, even if that means I

pay the consequences for it. Secondly, I dieted myself up to 480 lbs., why

on earth do I think that deprivation of a certain group of foods is going to

work this time? After all, with my surgery merely changed my body

composition, not my brain. I'm a big believer in getting to the root of the

problem, i.e. THE ADDICTION, and using the tool for help in moderation of

one's intake and one's behaviors.

>

> I'm 2 years post-op. On the day of my surgery, I weighed 459 lbs. Today

I weigh 198 lbs. My road hasn't been easy, by any stretch of the

imagination (mostly due to plastic surgery complications) but I'd do it all

again in a heartbeat. I eat what I want (with the exception of a lot of

milkfat), when I want IN MODERATION. I put on a few pounds when I was

drinking heavily (that story is on my website) and have lost about 30 since

August 2002, just by doing what I have always done, eating in moderation,

the foods I want.

>

> WLS is about finding what works for you. It's a tool that everyone

utilizes differently and that everyone must work out for themselves.

>

> Warmly,

>

> www.brandiland.com

>

> <<

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 doctors orders, to the letter.>>>

>

November 25, 2002

I understand what you are trying to say, however I respectfully disagree with

you.

Diets don't work, period. Getting to the root of your addiction does. Diets

aren't for life. Changing behaviors are. You can vomit and dump and be

educated and utilize the malabsorption functions of your surgery and your tastes

can change and you can limit your quantities, etc etc, etc. All of these things

help, however until you change the way you approach food and why you got to 480

lbs (I'm talking to me!), your life will be obsessed with food, just as it was

before. I always tout a book I hate the name of--- " The Seven Secrets of Thin

People " . The name turned me off so badly, I wasn't even going to read it. I'm

glad I did. It showed me how warped I was in my approach to food and how life

DID NOT have to be lived in the manner in which I was living.

Another thing, if one doesn't get one addiction in check, chances are pretty

high that one will find a substitute addiction to take its place. I speak from

initially undesired experience- ugh.

Warmly,

www.brandiland.com

. Why does dieting work now yet it never worked before?

1) Malabsorption

2) " forced " limited quantities

3) DUMPING

4) Better educated

5) Hormones that cut off the " feast/famine " signals

6) Change of tastebuds

7) Vomiting

8) More incentive to " maintain " a weight versus " get to " (for me personally

anyway)

November 25, 2002

,

Peanut butter works best for me too.

Also, I have to dry heave in order to feel better. It's like a ritualistic

thing. I seriously can't get through the dumping without dry heaving and making

this ugly airy, belchy sound (not belching-- though I wish it were because then

I'd probably feel soooo much better!) and spitting up some saliva.

Ok, that was pretty graphic :-)

Milkfat makes me dump horribly. Under normal circumstances, that alone stops me

from overindulging. However, the other night my homemade frappucinos with mint

chocolate chips, whip cream and colored red sugar dots tasted so good that I

kept on past what I knew to be ok and I paid DEARLY for it. It wasn't pretty.

And, I *think* I've learned my lesson this time...ha.

Warmly,

www.brandiland.com

I know there are many, many of us who have (or are still) or are just starting

to suffer with this. Whether it IS or is called late dumping (may or may not be

the same thing) or whether it's a blood sugar plummet off a cliff, I've had 'em,

and I call it misery.

Would those who know a little about it please chime in? My own attacks go like

so:

standing there minding my own business, hands go cold, mouth goes dry, knees

buckle and I crawl into kitchen. TODAY, I throw together &by than hands are

shaking violently, lights are flashing in front of eyes) a PBJ, fast, and start

eating ASAP. That seems to have arrested a few in progress.

Eating or drinking protein just before or during, using sugar to stop it (even

mixing some up in a glass to drink!)--nothing stops it like PBJ. That's 2 sides

PB, light film of J on trashy white bread. LOL!

Anyone else have any better recipe to snap out of it before hitting the floor?

Have done the blood a coupla times, but my glucomter only says : " LO " under 52.

I KNEW it was low, sheesh. But every other time I've tried it, my brain was too

intermittent to remember how to make it work. Scary.

OK, and here's another weird thing. I haven't had a debilitating one since

maybe last spring. Is there a 7.5 yr statute of limitations on this?

November 25, 2002

Well I guess that's why people have such differing opinions. I don't have any

" addictions " or deep dark secrets or problems!! I was 248 lbs because I wanted

and liked cheeseburgers and fries or spaghetti with Italian bread versus salad

with chicken!! This is what my taste buds wanted......soooo I had and still

have the choice to either eat the " weight gain " (bad) stuff (for me) and weigh

250 pounds and not get off the recliner chair and have no life, or eat the

" weight loss " (good) stuff and wear a size 12, feel incredible, have energy and

a LIFE!!! So,if the word diet means " the way one eats " than yes, I have to

permanently change my diet or I will not reach the goals I want in life!!!!!

Like several other people have said I think it is all in the " terms " used and

what those terms mean to each individual person! P.

Original Message -----

From:

To: nancy pugliese ; graduate-ossg ; rlogle@... ;

fbayuk@...

Sent: Monday, November 25, 2002 2:48 PM

Subject: Re: Dumping syndrome