VSG and Dumping Syndrome


Although uncommon, some post VSGrs report episodes of dumping syndrome,called Alimentary Hypoglycemia. Same rapid gastic emptying as seen in partial gastrectomy pertainig more to the liquid/fluid concentration of the intestinal tract. Same rapid gastric emptying seen in people who never had gastro or bariatric surgery also. Current medical data/ literature on VSG procedures do NOT eliminate the occurance of dumping but continue to suggest the occurance as 'minimal' post VSG. You will more than likely never see a stat or data on dumping in VSG it is so uncommon Recent information in dumping in partial gastrectomy shows occurance at 1% of surgeries.  True dumping is NOT the queasy, ick fatigue 'needing to lay down' one gets from eating processed high sugar type foods..on an empty stomach . It is NOT solely diarrhea, or solely nausea/ vomiting associated with eating too fast or overeating. It is a combination of 3 or more symptoms (list below). It is frightening so much so that some VSGrs may be compelled to go to the ER. 
Dumping syndrome in VSG...can occur with simple sugars carbs BUT it can occur with proteins: liquidy creamy, semi-soft proteins..(fluid concentrations of the intestinal tract),  and fats: esp  fried foods as well. 
The belief that dumping syndrome only occurs with high sugar (glucose from simple carbs rapidly emptying into the large intestine ) content foods is erroneous.  That is a reactive hypoglycemia, most common in 33% of RNYrs a reaction to simple sugar/carbs/glucose, and a behavior modification type surgery of choice for "sweet tooth" bariatric candidates. 

 I, personally have experienced dumping syndrome 3x's in 6 months post op. 
The FIRST episode at 2 months post op, then 4 and 5.5 months out. Symptoms  in all episodes inc. heart racing, diaphoresis (sweats), abdominal cramps, dizziness feeling like I was going to pass out en route to bathroom,  severe diarrhea.. food eaten in the toilet..undigested, unabsorbed. Then followed by EXTREME fatigue...needing to "sleep it off'  

2:3 episodes foods I dumped PROTEIN!!  1 cup "canned" 99% FF cream of chicken soup (5g carbs) at 4 months out, and 1/2 cup "canned" ground beef chili no beans (9gs carbs) at 5.5 months out.
These dumping episodes were totally RANDOM!   Ive had those same foods  since 1wk post op (soup) and  then again 2 weeks after dumping on them and NEVER had a problem with them before or after dumping episode. The fluid/concentration of my intestinal tract must have been prime. 


Majority of dumping in VSG forum posts reflect  no episodes of dumping syndrome post 6 months, as the case with me!,..perhaps due to stomach being fully healed, homeostasis  at that time. Important to note that dumping syndrome occurs in people who never had WL or GASTRO surgery. If dumping happens to you, realize: 

                                             THIS IS NOT IN YOUR HEAD.  VSGr's can and do DUMP!

The symptoms will pass depending on severity from 1-12 hours from personal experience which includes the extreme fatigue that follows an episode.  If persists consider seeking medical advice.

Prevention tip: do not eat simple sugars on an empty stomach unless you are at least 6 months out.  
Eat Protein (dense, firm, solids) BEFORE/FIRST!  Combne protein w/ simple carbs i.e. fruit with cheese, nut butters.  


The BEST remedies to overcome Dumping Syndrome: 
1, SOLID proteins  avoid creamy, liquidy protein foods  (decrease fluid concentration of intestinal tract)
2.  SOLUBE FIBER...to soak up excess fluids in the intestinal tract
3. REPLACE ELECTROLYTES lost  ..i.e pedilyte, G2s, Zero sports drinks.

The reason these episodes are called a syndrome is because usually one has 3 or more symptoms each occurance. Here is a list of symptoms:

                               Symptoms

Symptoms of dumping syndrome occur during a meal or within 15 to 30 minutes following a meal, they may include:

Nausea

Vomiting

Abdominal pain, cramps

Diarrhea

Dizziness, lightheadedness

Bloating, belching

Fatigue

Heart palpitations, rapid heart rate

Signs and symptoms may develop after 30 minutes, they may include:

Sweating

Weakness, fatigue

Dizziness, lightheadedness

Shakiness

Feelings of anxiety, nervousness

Heart palpitations, rapid heart rate

Fainting

Mental confusion

Diarrhea

Some people experience both early and late signs and symptoms. Conditions such as dizziness and heart palpitations can occur either early or late — or both.

Some people experience low blood sugar (hypoglycemia), related to excessive levels of insulin delivered to the bloodstream as part of the syndrome. Hypoglycemia is more often related to late signs and symptoms.

Gastrectomy and Dumping Syndrome:
http://emedicine.medscape.com/article/173594-overview

                    Alimentary hypoglycemia

Alimentary hypoglycemia is caused by food being dumped too quickly from the stomach into the small intestine. This causes the carbohydrate to be released too quickly, and this is followed by an over-reaction of the pancreas, and over production of insulin. Alimentary hypoglycemia occurs with an abnormality of the stomach, usually because of stomach surgery. Unlike the normal stomach, which can hold food over a long period, the reduced size of the stomach after surgery makes the holding time shorter. Alimentary hypoglycemia can also occur in some cases of gastrointestinal abnormalities not caused by surgery, depending on where in the system the problem is.

The sudden drop in blood sugar can be very dangerous and, in rare cases, can cause seizures and coma. Usually symptoms will appear a half hour to two and a half hours after eating.

                 Alimentary Hypoglycemia

Hypoglycemia is an affliction common among children and diabetic people, resulting from the body’s natural defense mechanisms reacting wrongly to blood sugar levels that are too high or too low. There are different and varying types of hypoglycemia based on their causes but the most severe type is what they call Alimentary Hypoglycemia.

Alimentary is a word that pertains to or concerns food, and while hypoglycemia itself concerns food and their glucose contents, none is more directly related to actual food than this type of hypoglycemia.

Unlike other forms of hypoglycemia, which result in consumption or lack of blood glucose, Alimentary Hypoglycemia happens when food that you have chewed and swallowed is dumped too quickly from the stomach to the small intestine. This abnormal occurrence causes all the carbohydrates in your food to be released faster than intended, and will immediately prompt the pancreas to overreact, which in turn releases far too much insulin, driving the body’s glucose levels far too fast and too low than your body was designed to handle. This sudden drop in blood glucose levels is among the most severe in all hypoglycemia types, and can cause seizures and even put the patient in a comatose state.

Alimentary hypoglycemia has two subgroups, with the first one occurring to those who do not have any experience with gastric surgery in the past, and the second one being for those who have had prior gastric surgery, either with gastric resection or vagotomy. With the second subgroup, the severest form of alimentary hypoglycemia may occur after subtotal gastric resection, and the constant defecation resulting from diarrhea may further complicate management and treatment. Patients suffering from this irregular digestive system will greatly benefit from a diet rich in soluble fiber while a person with normally functioning digestion should focus more on foods rich in fiber.

Alimentary hypoglycemia tends to happen after mealtime, and is usually caused by excessive moving such as jumping, running or brisk walking. In order to avoid this reactive form of hypoglycemia, it is best to take a few minutes of rest after every meal to ensure that the food you ate has settled down and can be digested thoroughly and properly. Children in particular are very prone to this kind of hypoglycemia, as kids have a habit of immediately running, jumping or playing around after a heavy meal. As such, it is important for the parents to regulate their children’s activities and implementing strict rules regarding behavior after eating.

Alimentary types of hypoglycemia can also be caused by improper administering of medicines that affect the body’s adrenal glands, particularly energy-regulating ones that promote and could result in excessive production of adrenalin, effectively putting the body in a state that digests food faster than normal, and laying havoc to the digestive system.

Always remember that hypoglycemia happens even to people who are not suffering from diabetes, and it is very important to be responsible with your eating habits and daily activities in order to prevent developing or triggering a hypoglycemia attack.

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Four Corners, NM
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09/10/2008
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