Re: -hypoglycemia???

[Guest guest]

this happens to me with fats oan/ or sugars

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.

<http://www.sabariatric.com/>

<http://www.sabariatric.com/side_effects.htm>

<http://www.sabariatric.com/common_problems.htm>

This page was last updated on: 11/07/00

>hi my name is jennifer and i am usualy a lurker, however i have

>been

> > having some symptoms. i had rny gastric bypass on 8-28-01, lost

> > 230lbs. i have been very stressed lately and not eating right.

>maybe

> > i would eat once a day or something to that effect. last night

>around

> > 5pm i went to mama mima's italian rest. i had 2 1/2 garlic rolls

>and

> > some fried calamari, about 2 hrs later i was going to target and

>when

> > i started walking in i had this strange feeling, like anxious

>feeling

> > and my hands were shaking and it felt like my whole body inside

>was

> > shaking, i thought i was going to faint and then shortly after i

>got

> > very tired. i called my dr today and she said it sounded like

> > reactive hypoglycemia. she is going to test me for it, my question

>is

> > has anyone else had this happen so far after surgery and its not

>like

> > im just starting to eat carbs. ive been eating carbs, so why all

>of a

> > sudden this reaction last night? any responses would be greatly

> > appreciated....thank you.

> >

> >

>