Dumping Syndrome: What It Is and How To Avoid It!

If you're planning gastric bypass surgery you need to know what dumping syndrome is and how to avoid it!

This lovely sounding syndrome results from the rapid passage (or "dumping") of undigested food into the small intestine, causing a rapid shift of fluid as the body tries to "dilute" the contents of the intestine. This shift in fluid causes cramping and diarrhea and can also result in a drop in blood pressure, causing weakness and sweating.

Why does gastric bypass make this possible?

Well, as a result of the surgery, you no longer have the valve that regulates how fast food empties out of the stomach. The surgery also causes food to enter the gastrointestinal tract at a point lower down than it's supposed to due to the first part of the small intestine having been "bypassed."

That first part of the small intestine is where sugars normally are metabolized. So basically you're now dumping sugar lower in the intestines, where they aren't equipped to handle it. The result: your body rebels!

Translation...

...eat the wrong thing and you can feel really really sick for many hours.

Here's one patient's account of what dumping syndome feels like:

Shortly after eating a food I don’t tolerate (sugar, milk, sugary milk products or starchy carbs) I begin to feel a bit disoriented, maybe dizzy and then an overall sense of confusion or panic takes over my mind and body. This is a mild state of delirium. Then I begin sweating. Profuse sweating that can completely soak my hair, my clothes; it drips and glistens on my skin. During this state of sweaty panic I feel like I’m out of my mind! A few times during extremely dramatic dumping episodes I literally thought I was dying, the state of distress was that severe.

Dumping syndrome can cause diarrhea, nausea, vomiting, increased heart rate, sweating and cramping. Symptoms can occur immediately ("early dumping") or 1-3 hours after eating ("late dumping").

Causes of Dumping Syndrome

• Eating sweets or foods high in sugar
• Eating too much at one meal
• Having solids and fluids together
• Eating foods that are fried, fatty, or greasy

How To Avoid Dumping Syndrome

• Avoid/limit concentrated sugars like cookies, cake, pies, sugar, and syrup.
• Read food labels for sugar content. Avoid foods with sugar listed among the first three ingredients.
• Eat six small meals daily instead of three large meals.
• Eat slowly.
• Avoid eating and drinking at the same time. Wait 30 minutes before and after a meal to drink fluids. Drink low sugar beverages only.

A Note About Sugar

"Sugar Free" foods and drinks often contain sugar alcohols which may not be well tolerated either. So note:

Words ending in -ose are generally forms of sugar.

The following is a list of sugars and sugar alcohols to try to avoid:

• barley malt
• brown sugar
• cane sugar
• confectioner's sugar
• corn syrup
• corn sweeteners
• dextrose
• fructose
• glucose
• granulated sugar
• honey
• high fructose corn syrup
• invert sugar
• isomalt
• lactose
• lactitol
• levulose
• maltose
• mannitol
• maple syrup
• molasses
• raw sugar
• sorghum
• sucrose
• sorbitol
• turbinado
• table sugar
• xylitol

While dumping sydrome is certainly no fun to experience, the negative feedback is often a convincing motivator to stick to your post weight loss surgery diet guidelines! If you'd always wished your dentist could have just pulled out that "sweet tooth," this could be the next best thing.

I've had patient after patient tell me how their addiction to sugar was instantly broken after experiencing dumping syndrome.

Foods Best Tolerated After Gastric Bypass Surgery

• Grains: plain breads, buns, bagels, and crackers, unsweetened cereals, pasta, rice
• Vegetables: All
• Meats/meatless protein: meat, poultry, fish, beans, peanut butter, protein powder/protein shakes
• Dairy: 1%, 2% or skim milk, lowfat buttermilk, lowfat cheese, sugar-free pudding, yogurt sweetened with sugar substitute.
• Fats: butter, cream, margarine, oils, fats, mayonnaise, salad dressings...IN MODERATION
• Sweets: sugar-free gelatin or custard, sugar free ice cream, sugar substitutes.
• Beverages: water, tea, coffee, diet soda, sugar free beverages

Foods Less Tolerated After Gastric Bypass Surgery

• Grains: sweetened cereals; donuts and sweet rolls.
• Fruits: frozen or dried fruit, fruit cooked or canned with sugar, sweetened fruit juice, prune juice
• Vegetables: none
• Dairy: Whole milk, malted or chocolate milk, sweetened custard, pudding, or yogurt
• Fats/Oils: Okay, but easy does it!
• Sweets: Cakes, cookies, pies, pastries, puddings, sherbert, ice cream, milkshakes, gelatin, candy, sugar, jams, jellies, honey, syrup (you know...all the yummies!)
• Beverages: regular soda, sweetened drink mixes and tea, Koolaid, fruit drinks, and punch

EXERCISE AND BARIATRIC SURGERY



Exercise is an important part of a successful gastric bypass surgery. Done properly and under supervision, exercise speeds healing and recovery. Getting started on any post surgical exercise program is difficult. It may be even more difficult for people who were unaccustomed or unable to exercise previously due to excessive weight. If you create an exercise program based on your likes and dislikes and work at it a little each day, you will be more likely to stick with it over the long haul.  Here are some helpful tips to create your own personal exercise program to assist with your weight loss success:

1. Discuss all exercises, from the first day of stretching onward, with your doctor. You will want to exercise as soon as possible, but don't rush into against your doctor's advice.
2. Acknowledge that lack of exercise may have contributed to your weight problem.
3. Commit to making a daily exercise program part of your lifestyle after gastric bypass surgery.
4. Start slowly. With your doctor's consent, try a few light stretches in bed the morning after your surgery.
5. Begin to exercise as soon as possible. Barring complications, you should be up and taking a few steps the day after your surgery.
6. Walk, walk, walk during the initial recovery period. Walk several times a day, even if you can only last for two or three minutes. Until your doctor gives the OK, walk on flat even surfaces, not grades.
7. Avoid abdominal exercises until they have been approved by your doctor--usually at least four to six weeks after surgery.
8. Burn fat, not muscle. Your body will be getting fewer calories after your surgery. To replace the lost energy, a sedentary body may burn muscle rather than fat. Exercise will burn fat.
9. Create a multi-front plan that keeps you interested and provides comprehensive exercise, including cardiovascular, aerobic, flexibility and endurance portions.
10. Lift weights after your doctor has informed you that your wounds are sufficiently healed. Gastric bypass patients are at greater risk for osteoporosis. Weight bearing exercise is a great way to battle bone loss
11. Enroll in a water aerobics class after your doctor has released you to be in water. Swimming really works the abdominal muscles, so delay actually doing that until you have received the go ahead from your physician.

Read more: How to Create an Exercise Program After Gastric Bypass Surgery | eHow.com http://www.ehow.com/how_2052201_create-exercise-program-after-gastric.html#ixzz1v2r1IbS4

Vitamin/Mineral Supplement for Bariatric Surgery Patients

Gastric Bypass and other types of Bariatric Surgery dramatically alter your body's ability to absorb vitamins, minerals, and nutrients from the smaller amounts of food you are eating. The resulting vitamin and mineral deficiencies can have serious medical implications.

Vitamins and minerals contribute to your post bariatric surgery health in a number of ways, including the regulation of the metabolism and helping with the release of energy from the food you digest. In comparison to nutrients like protein, carbohydrates and fat, vitamins and minerals are needed in much smaller amounts by your body. Vitamins are classified as either water-soluble or fat-soluble. Water-soluble vitamins cannot be stored in the body and must be taken every day. Water-soluble vitamins include the B vitamins and Vitamin C. On the other hand, fat-soluble vitamins are stored in the body's fat and include vitamins A, D, E and K. Minerals are needed by your body for the proper composition of body fluids, maintaining healthy bones and teeth, formulation of healthy blood, regulation of heart, muscle and nerve functions.

As a bariatric surgery patient, it is absolutely essential that you take a good quality multiple vitamin and mineral product daily, for the rest of your life. You will also need to take additional calcium, Vitamin B-12 and perhaps Iron supplements. In some cases, Vitamin C and Zinc (optional) supplementation may also be appropriate. Although the specific amounts and types of vitamin and mineral supplements may vary by bariatric practice, bariatric surgeons and dietitians agree that these supplements are necessary to prevent vitamin and mineral deficiencies after bariatric surgery.

There are a variety of high quality vitamin and mineral supplements that will meet the needs of the bariatric surgery patient. If you have difficulty tolerating any of the supplements, make sure to call your dietitian of surgeon for suggestions. Consult with your bariatric health care provider before taking vitamin and mineral supplements.

Supplement	Type	Function	Schedule	Interactions
Multi-Vitamin and Mineral	Chewable or complete one-a-day multi vitamin/mineral supplement.	Multi-vitamin/mineral supplements ensure that you are getting enough of all of the micronutrients you need.	Take one to three times a day with meals or as directed by your doctor.	None
Vitamin B-12	Sublingual Vitamin B-12 tablet, (at least 500 mcg per tablet) each day, or injectable B-12 (1,000 mcg) per month.	Helps with proper blood cell formation and nerve function. Deficiency may cause certain types of anemia.	Take one sublingual tablet daily, or as directed by your doctor. Allow tablet to dissolve in under the tongue.	None
Calcium	Chewable or crushable Calcium Citrate (500 mg, two to three times a day) Calcium Citrate is recommended due to it's superior absorption, without requiring stomach acid. A calcium citrate supplement that includes Vitamin D will also aid absorption.	Builds and maintains bone strength. Also helps the heart pump and muscles contract properly. Helps with proper blood clotting and aids in the repair of soft tissue.	Take 500-600 mg doses two to three times per day for a total of 1,000 to 1,800 mg per day, or as directed by your doctor. Take one hour apart from other vitamins and minerals (especially iron).	Do not take at the same time as iron. Calcium competes with iron for absorption. Caffeinated products, spinach and whole wheat products may also decrease absorption.
Iron	Tablets, chewables or liquids.	Vital to the formation of red blood cells tht provide oxygen to the human body. Prevents anemia.	Take daily as directed by your doctor. Take with vitamin C to aid in absoption.	Do not take at the same time as calcium. Iron competes with calcium for absorption.
Vitamin C	500 mg tablets or chewables.	Promotes wound healing and reduces chance of infection. Aids in body's calcium levels and bone formation. Enhances iron absoption.	Take as directed by your doctor. Take with iron.	Certain antacids may interfere with absorption.
Zinc	Optional. Tablets or lozenges.	Helps with wound healing and supports the immune system. Loss of hair may indicate a Zinc deficiency.	Take 10 to 20 mg per day or as directed by your doctor.	Too much zinc may interfere with the absorption of other nutrients.

Information provided from http://www.bariatricchoice.com/

What Is The Best Option For Me??

There are several options for individuals to chose for your weight loss journey, but which one is the right one for you? Some decisions are based on BMI or health problems, but some decisions are made due to fear or uncertainty of what the outcome may be for certain procedures.

Some criteria that has to be met before surgery can considered are a BMI (body mass index) of atleast 40 or atleast 35 with one or more serious obesity-related conditions.  Are at least 18 years of age and have failed more conservative weight lose alternatives such as a supervised diet, exercise, and behavior modification programs.

What are the procedures Physicians East Surgical Weight Loss Center offers?

Gastric Banding:
During the gastric band procedure, the REALIZE Band is placed around the uppermost part of the stomach, dividing it into two parts: a small upper pouch and a lower stomach. The upper pouch can hold only about 4 ounces (1/2 cup) of food. As a result, you eat less food at one time, feel full sooner, and feel satisfied longer. The goal is to lose weight gradually, at a healthy rate of 1 to 2 pounds per week.
No part of your stomach is stapled or removed during surgery, and your intestines are not rerouted, so you can continue to absorb nutrients from food. This surgery can be laparoscopic or open depending on your individual situation for more information on gastric banding click on the link.

Gastric Bypass:
Gastric bypass uses both a restrictive and a malabsorptive surgery technique. It restricts food intake and the amount of calories and nutrients the body absorbs. In addition to creating a smaller stomach pouch, the surgery changes the body's normal digestive process. As a result, food bypasses a large part of the stomach and most of the small intestine. This surgery can also be done laparoscopic or open depending on your individual situation for more information on gastric bypass click on the link.

Sleeve Gastrectomy:
During this procedure, a thin vertical sleeve of stomach is created using a stapling device, and the rest of the stomach is removed. The sleeve is about the size of a banana. This procedure limits the amount of food you can eat and helps you feel full sooner. It allows for normal digestion and absorption. Food consumed passes through the digestive tract in the usual order, allowing it to be fully absorbed in the body.  The majority of weight loss sleeve gastrectomies performed today use a laparoscopic technique, which is considered minimally invasive. Laparoscopic surgery usually results in a shorter hospital stay, faster recovery, smaller scars, and less pain than open surgical procedures. For more information on the procedure sleeve gastrectomy click on the link.

Feeling Ready to Attend one of our Patient Education Classes? Check out our Seminar schedule and give us a call at 252-413-6735 and enroll in one of our classes today!!!   Dr. MacDonald, Dr McGuire, and the staff look forward to meeting with you to discuss your weight loss options.

If your not there yet then make sure you do the research and talk with those who have experienced the surgery such as attendees at our Bariatric Support Group which meets the 4th Wednesday of each month.  We would love to have you visit our support group and please feel free to bring family or friends along to get information from important bariatric speakers each month.