Tuesday, September 07, 2010

What is Dumping Syndrome?

I've written about my own experiences with dumping syndrome a couple of time -- The Sugar Surprise and details about the fact that I Don't Dump. But I don't think I've ever explained what happens inside our body when dumping is happening. So here we go...

Each person is different when it comes to dumping. The scenario below outlines the typical biological reactions of dumping syndrome – but any one of these steps might be skipped or intensified in each different person who dumps. For some people dumping will last 20 minutes and they instantly feel better. Some people suffer for hours or even days. Nikki proclaims she’s a three-day-dumper as it takes her body a full three days to get back to normal afterward. We’re all different and each one of us won’t know what dumping is like until we actually experience it for ourselves.

Here's a pretty good explanation of dumping syndrome:

When stomach contents are literally "dumped" rapidly into the small intestine. Sometimes triggered by too much sugar or fat in food. Dumping symptoms aren't fun: nausea, cramping, weakness, sweating, faintness, and diarrhea. Some patients can prevent dumping syndrome by avoiding offending foods after surgery.

Let’s break it down into steps.

  1. We eat some type of food with too much sugar or too much fat – it’s the content of the food that is the trigger for dumping, not the texture or consistency of the food. 
  2. In a normal stomach (before surgery) simple carbohydrates like refined sugar are broken down within the stomach with enzymes designed specifically for that taste. But after surgery we no longer have a normal stomach and because we have no pyloric valve to keep food in the stomach pouch until it’s been broken down with gastric acid or enzymes, these foods are emptied from the pouch into the small intestines fairly quickly.
  3. Once this food reaches the intestines, the body is unable to break down the sugar/fat so it tries to get rid of the offending food as quickly as possible. The body literally goes into panic mode.
  4. Fluid from all over the body is rushed to the intestines to help flush the food out – this causes intestinal cramping and a bloated feeling.
  5. The body is in panicked survival mode or fight-or-flight mode, so it releases endorphins to help ensure its survival – this causes rapid heartbeat and sometimes increased blood pressure and often sweating or an overheated feeling.
  6. The body realizes there’s too much sugar in the system – this will show as a spike in your blood glucose levels. Because of these elevated blood glucose levels, the body then releases extra insulin to help “soak up” some of that sugar and process it as quickly as possible – this will often show as a dramatic drop in blood glucose levels and may result in a hypoglycemic reaction.
  7. As a result of the excess fluid in the intestinal tract and the body’s all out effort to rid itself of the offending food, we’ll often end up with diarrhea or an urgent need to use the bathroom. Some people also report an excess amount of urination after a dumping episode.
But how many people actually dump after RNY? Is it everyone or is it only some people?

According to the ASMBS:

About 85% of gastric bypass patients will experience dumping syndrome at some point after surgery.

Ok... so to me the key phrase there is "at some point". Let's take the Sugar Surprise story - I dumped that once when I was about 4 months post-op after I accidentally drank a million grams of sugar (80g or so, actually). So yeah, I dumped bad on that mistake. But I have never dumped since that day. Not because I've never eaten sugar again, but because I have such a high threshold for sugar tolerance that I consider myself a non-dumper. I can easily eat about 35g sugar in a sitting and not dump. So even though I'm a non-dumper, I'd still contribute to that statistic of 85% because I did dump once after surgery.

Ok... so then there's the other school of thought based on a study by Braghetto, et al where about 41% of people dump on sugar or fat (combined). And notice that 41% was considered non-severe dumping. Those 3-day dumper are rare (about 5%). So, I am more inclined to subscribe to this notion instead of the 85%. Here's an article about dumping syndrome in various sets of patient population -- because dumping is not exclusive to RNY, it happens with other people too.

In persons with long segment Barrett esophagus treated with a truncal vagotomy, partial gastrectomy, plus Roux-en-Y gastrojejunostomy, 41% developed dumping within the first 6 months after surgery, but severe dumping is rare (5% of cases).

Some people don’t have a problem with sugar but dump on too much fat and vice versa. Many people who don’t experience physical symptoms may actually be experiencing medical symptoms though.

As I mentioned earlier, I consider myself part of the 59% of patients who do not dump. However, because I do experience dumping symptoms if I push my limits too far, technically I guess I am a dumper. My threshold is about 30g sugar before I start to feel the effects. That's a package of peanut M&M's or a whole slice of cake. Yes, I've eaten both of those things. No I don't eat them often … in fact it's rare for me to ever get up to that 25g limit. I'm perfectly satisfied with 2 bites of birthday cake and my chocolate craving is easily satisfied with three M&M's or one Dove Chocolate. Even though I have a high threshold for sugar, I still behave as if I do experience dumping syndrome and limit my sugar intake like any other RNY patient.

Most commonly the doctor recommended limit for sugar intake per meal is “single digits of sugar” – so 9g or less is a good rule of thumb.

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