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Everything you ever wanted to know about dumping...

cabin111
on 11/30/13 9:08 pm

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

H.a.l.a. B.
on 11/30/13 11:32 pm
RNY on 05/14/08 with

Thanks For posting that. 

H.a.l.a RNY 5/14/2008    

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krabbyhermit
on 12/1/13 10:17 am

Very informative! 

In all my days ahead I vow to be kind to myself. This shall also be a new and exciting experience. 

    
kellys_thought
on 12/1/13 2:40 pm
RNY on 05/13/09 with

That was an excellent post!  You put alot of experience and thought into it.  I respect that.   I can't wait to share this post.  I am anxious to read more on the Pectin you mentioned. 

 

Thanks Again

Grim_Traveller
on 12/1/13 3:43 pm
RNY on 08/21/13

Thanks.

 

   

High weight: 475, BMI 59.4 Surgery weight 359, Current weight 185, BMI 23.1

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