Needing a refresher regarding alcohols and sugars
I've also discovered that I like wine. But only the sweet wine. The sweeter the better. I can usually (99% of the time) only have what would equal 1/3C of wine before I feel the effects of the alcohol. So, I almost never drink more than that.
To reinforce my mind a bit, please remind me of the "dangers" of sugar and alcohol to my fairly new plumbing. (I'm 25 months out and have lost 127#)
Thank you for all your help.
What is dumping?
dlife via OAC -
Dumping syndrome is a group of symptoms caused by rapid passage of undigested food into the small intestine. The stomach has a valve at the top and bottom, and serves as an acid-filled storage tank, breaking food intake down into small, component parts and passing it to the small bowel in small increments.
After gastric bypass, ingested food passes directly into the small bowel, mixed only with saliva, but not the stomach acid. The component parts of the undigested food remain fairly intact and therefore large.
The small intestine responds by diluting the ingested food through a process of “water recruitment." The “richer" the food, in terms of sugar content, the more water will rush into the small intestine to dilute it. This is referred to as “early dumping."
Early Dumping and Late Dumping
Early dumping occurs a few minutes to 45 minutes after eating. Symptoms are not life-threatening, but can be frightening to the unsuspecting patient. Symptoms of early dumping are:
- Weakness and fainting
- Sweating
- Irregular and rapid heartbeat
- Low blood pressure
- Flushing of the skin
- Dizziness
- Shortness of breath
- Vomiting
- Diarrhea and cramps
Late dumping occurs two to three hours after eating. It is caused by excess insulin produced in response to rapid entry of food and fluids into the small intestine. The high insulin levels lower low blood glucose level and cause symptoms including:
- Perspiration
- Hunger
- Shakiness
- Anxiety
- Difficulty to concentrate
- Exhaustion
- Faintness
The diagnosis of late dumping syndrome can often be confirmed through frequent blood sampling to measureblood glucose.
You can prevent early and late dumping by avoiding the foods that cause dumping. In other words – sugars, starches, and fried foods. Eat at least five to six small, evenly spaced meals a day. Take meals dry (i.e. withou****er or beverages, and drink fluids only between meals). Because carbohydrate intake is restricted, protein and fat intake should be increased to fulfill energy needs. Examples include meats, cheeses, eggs, nuts, toast, potatoes, and rice crackers. Milk and milk products are generally not tolerated and should be avoided.
Each person has a different tolerance, and you will discover what your personal safe foods might be throughout your post surgery life. Person “A" might have no problem with strawberries and person “B" might experience dumping every time a few strawberries are eaten and person “C" might be able to eat strawberries only if they are a little unripe. You will learn what your own trigger foods might be. Be aware that these may change over time as your bypass matures.
Alcohol -
Study - Gastric Bypass Increases Risk for New-Onset Alcohol Abuse
And, from the "No, really?" files --
A study of 340 patients who underwent Roux-en-Y gastric bypass surgery in Boston found that the surgery increases the risk of new-onset alcohol abuse, Medscape Medical News reported.
Stephanie Sogg, PhD, a clinical staff psychologist at the Massachusetts General Hospital Weight Center in Boston, said she looked into the link after hearing anecdotal evidence about middle-age patients becoming dependent on alcohol.
Ms. Sogg and other research conducted phone interviews with participants to ask about their alcohol intake before and after surgery. More than two-thirds said alcohol affected them more after surgery. Seven percent reported developing a drinking problem after surgery.
The poster was presented at Obesity 2011: The Obesity Society's 29th Annual Scientific Meeting.
"Our data underscore the need for asking patients during their preop evaluation about their use of alcohol, and again when following up after surgery," presenter Stephanie Sogg, PhD, told Medscape Medical News. Dr. Sogg is a clinical staff psychologist at the Massachusetts General Hospital Weight Center in Boston.
Dr. Sogg said that several years ago she began hearing from patients that not only was alcohol having a far greater effect on them after surgery than before, but also that some were developing full-blown alcoholism after surgery — even if they had never had a previous problem with drinking.
And what was most intriguing, Dr. Sogg said, was that many of the people who were becoming alcoholics were middle-aged. That is long after most people begin to have alcohol-related problems. Data from the National Institute on Alcohol Abuse and Alcoholism indicate that the mean age of onset of alcohol abuse is 22 years.
"Although there's not much in the literature on the subject of alcohol abuse following Roux-en-Y surgery, there's quite a lot of discussion among weight loss specialists — anecdotal evidence — that this is a problem," she said.
To find out more about a possible link, Dr. Sogg and her colleagues conducted telephone interviews with 340 patients who had undergone RYGB surgery at Massachusetts General Hospital in Boston. All procedures had been carried out at least 18 months before the survey.
About three quarters of the patients were female, and 91% were white. Mean age at the time of surgery was 46 years, and the mean time since surgery was 57 months.
Surveyors asked patients to quantify their preoperative and postoperative alcohol intake. Patients were also asked about how alcohol affected them both before and after surgery.
"We decided to ask about quantity and frequency rather than specific symptoms of alcohol abuse," Dr. Sogg said. "That’s because we felt patients would be more comfortable reporting quantitative data rather than answering more subjective questions about their drinking."
More than two thirds of participants said they were affected more by alcohol after surgery than before, she said.
Problem drinking was defined as consuming at least 3 drinks per day on at least 4 days per week, or having 5 or more drinks on at least 2 days per month.
"We found a significant increase in risk of new-onset postsurgical alcohol abuse among these patients," Dr. Sogg said.
They defined "remote" problem drinking as problem drinking that had ceased more than 6 months before surgery. If patients were having drinking problems within the 6 months before surgery, that was defined as "immediate" problem drinking, Dr. Sogg explained.
About 21% of participants reported having drinking problems at some point before surgery. In all, 15% reported a remote history and 6.5% reported having an immediate problem.
Approximately 9% of participants reported a period of problem drinking after their surgery. Problem drinking after surgery was associated with younger age (P = .040), longer time since surgery (P = .001), and a higher baseline body mass index (P = .049).
"Drinking problems within 6 months prior to surgery strongly predicted problem drinking after surgery," Dr. Sogg said. The odds ratio was 6.59 (P = .0005).
However, a remote history of problem drinking was not associated with having drinking problems after surgery (odds ratio, 1.01; P = .99), she noted.
Of particular note, Dr. Sogg said, was that 7% of patients surveyed reported new-onset problem drinking after RYGB.
However, no clinical or demographic variables were identified as predictors of new-onset drinking problems.
"In the population as a whole about 90% of alcohol problems develop before the mid-30s," Dr. Sogg said. "The mean age of our sample was 46. So it's troubling to find how relatively common new-onset alcohol problems were in this population of patients."
Another observation Dr. Sogg said she has made over the years — but didn’t include in the present study — is how quickly drinking problems seem to progress in post-surgery patients. "Alcohol abuse is usually a gradual-onset problem, but in many of our patients who develop drinking problems, it seems to rapidly ramp up, escalating very quickly."
On the basis of her study results, Dr. Sogg said clinicians need to increase their focus on the potential of alcohol-related RYGB complications. "That means better patient education, better screening, and better efforts at prevention, both before and after surgery," she said.
"I think what this study clearly tells us is that alcohol can be a problem after surgery for some of these patients. And we especially need to watch people who had problems with drinking up to the time of surgery," said Leslie Heinberg, PhD, director of behavioral sciences at the Bariatric and Metabolic Institute, Cleveland Clinic, Ohio, in an interview with Medscape Medical News.
She emphasized, however, that patients in the study *****ported a remote history of alcohol problems before surgery were not at increased risk for postoperative drinking problems.
Dr. Heinberg, who is also associate professor at the Cleveland Clinic Lerner College of Medicine, said that in their program she and her colleagues are very careful to counsel all their patients about the physiologic changes that take place during surgery and how those changes will make patients permanently more susceptible to alcohol.
"We make sure they understand that if increased susceptibility is something that’s likely to create problems for them, they might want to reconsider having the surgery," she said.
Dr. Sogg and Dr. Heinberg have disclosed no relevant financial relationships.
Obesity 2011: The Obesity Society 29th Annual Scientific Meeting; Abstract #21-OR. Presented October 5, 2011.
Medscape - More on alcohol and WLS.
Physicians should warn gastric bypass patients that they may not be as tolerant of alcohol as they were prior to surgery, one researcher urged.
...The procedure may lead to metabolic changes that potentially affect the patient's sensitivity to even small amounts of drink, Peter Holt, MD, of Rockefeller University in New York City, wrote in a letter to The Lancet.
Holt said the data "mandate" that clinicians warn patients having Roux-en-Y gastric bypass surgery that they could experience "a major difference in their capacity to handle alcohol after their surgery." They also may want to consider not driving "after drinking any alcohol at all."
Most bariatric surgeons said they do warn patients that their tolerance for alcohol will change after the procedure.
"I tell them they will be a cheap date," Mitchell Roslin, MD, a bariatric surgeon at Lenox Hill Hospital in New York City, told MedPage Today in an email. He said alcohol is rapidly passed into the small bowel where it is quickly absorbed into the blood stream.
Richard Stahl, MD, lead gastrointestinal surgeon at the University of Alabama at Birmingham, told MedPage Today that he warns patients about the potential change in alcohol tolerance, but said it's likely that other clinicians aren't sufficiently educating patients.
In his letter, Holt briefly reviewed a number of studies on alcohol metabolism after gastric bypass and concluded that patients "should be very concerned about elevated blood (and breath) alcohol concentrations out of proportion to intake."
The changes may be due to alcohol-producing bacteria that accumulate in the bypassed duodenal-jejunal loop. It's been shown that bacteria accumulating in stagnant loops of intestine can produce ethanol from carbohydrates, Holt wrote.
In fact, one study showed that small amounts of alcohol have been detected in the blood of jejunoileal bypass patients and in obese women. Stahl noted that these concentrations, however, don't produce clinical effects. Thus, the patients don't feel intoxicated.
Another study found elevated peak alcohol concentrations and a significant delay in the return of alcohol levels to baseline concentrations after drinking just one glass of wine six months after surgery.
Stahl said it's easy to see why quick absorption into the bloodstream can increase blood alcohol concentrations rapidly, but it's not clear why it takes so long for those levels to subside.
Holt wrote that gastric bypass patients generally report greater sensitivity to small amounts of alcohol, with rapid intoxication and lower tolerance than before surgery.
He noted that the letter was prompted by one patient's misadventure from several years ago. The patient had a minor traffic accident and was given a breathalyser test, which indicated moderate intoxication.
The reading was much to the patient's surprise, Holt wrote, because many hours had passed since he had imbibed only one glass of wine.
Although gastric bypass patients are clearly told to lower their overall caloric intake in order to augment their weight loss, there are other foods besides alcohol that can have significant metabolic effects after surgery, such as sweets.
"Sweets are bad, and not just from a caloric standpoint," Stahl said. "They also cause dumping syndrome."
That's essentially the body's way of dealing with an overload of sugars that have rapidly crossed directly from the stomach into the bloodstream, he explained. It makes patients feel flushed and bloated and can increase heart rate.
"They just feel really awful, and it happens within minutes of eating that food," he said, adding that the initial symptoms are often followed a couple hours later with a second round due to low concentrations of blood sugar.
Primary source: The Lancet
Source reference:
Holt RP "Changes in alcohol metabolism after gastric bypass surgery" Lancet 2011; 378: 767.
Alcohol is awful for you. It's a waste of calories, can cause severe blood sugar fluctuations and indirectly kill you.
Sugar can make you feel like crap, cause dumping and reactive hypoglycemia, but likely will NOT kill you unless you have severe reactive hypoglycemia and fall into a coma.
Batwingsman · 5 replies · 1545 views