This article copied from wikipedia on Gastric dumping syndrome, or rapid gastric emptying is a condition where ingested foods bypass the stomach too rapidly and enter the small intestine largely undigested. It happens when the upper end of the small intestine, the duodenum, expands too quickly due to the presence of hyperosmolar (substances with increased osmolarity) food from the stomach.

"Early" dumping begins concurrently or immediately succeeding a meal. Symptoms of early dumping include nausea, vomiting, bloating, cramping, diarrhea, dizziness and fatigue. "Late" dumping happens 1 to 3 hours after eating. Symptoms of late dumping include weakness, sweating, and dizziness. Many people have both types. The syndrome is most often associated with gastric surgery.

It is speculated that "early" dumping is associated with difficulty digesting fats while "late" dumping is associated with carbohydrates.^{[citation needed]}

Rapid loading of the small intestine with hypertonic stomach contents can lead to rapid entry of water into the intestinal lumen. Osmotic diarrhea, distension of the small bowel (leading to crampy abdominal pain), and hypovolemia can result.

In addition, people with this syndrome often suffer from low blood sugar, or hypoglycemia, because the rapid "dumping" of food triggers the pancreas to release excessive amounts of insulin into the bloodstream. This type of hypoglycemia is referred to as "alimentary hypoglycemia".

Diagnosis

Physicians diagnose dumping syndrome primarily on the basis of symptoms in patients who have had gastric surgery. Tests may be needed to exclude other conditions that have similar symptoms. Two ways of determining if a patient has dumping syndrome include Barium fluoroscopy and radionuclide scintigraphy.

In the first procedure, a contrast of barium-labeled medium is ingested, and x-ray images are taken; early dumping can be easily recognized by premature emptying of the contrastmedium from the stomach.

The second method, scintigraphy (or radionuclide scanning), involves a similar procedure in which a labeled medium containing ^99mTc (or other radionuclide) colloid or chelate is ingested. The ^99mTc isotope decays in the stomach, and the gamma photons emitted are detected by a gamma camera; the radioactivity of the area of interest (the stomach) can then be plotted against time on a graph. Patients with dumping syndrome generally exhibit steep drops in their activity plots, corresponding to abnormally rapid emptying of gastric contents into theduodenum.

Treatment

Dumping syndrome is largely avoidable by avoiding certain foods that are likely to cause it, therefore having a balanced diet is important. Treatment includes changes in eating habits and medication. People who have gastric dumping syndrome need to eat several small meals a day that are low in carbohydrates, avoiding simple sugars, and should drink liquids between meals, not with them. Fibers delay gastric emptying and reduce insulin peaks. People with severe cases take medicine such as octreotide, cholestyramine or proton pump inhibitors(such as pantoprazole) to slow their digestion. Doctors may also recommend surgery. Surgical intervention may include conversion of a Billroth II to a Roux-en Y gastrojejunostomy.

Most of the text of this article is taken from http://digestive.niddk.nih.gov/ddiseases/pubs/rapidgastricemptying/index.htm

Well, weight loss surgery champions that is. Champion, because today just happens to be my weight-loss surgery 4th anniversary.

And also a "champion" because although there have been a few tears of frustration during the last few months, I did have a successful breakfast for my hypoglycemia.

Breakfast

Almost the same as yesterday, but with a little tweaking I lasted a full three hours till lunch, yeah!

• 1 fried egg
• 1 turkey sausage patty
• 1/4 buckwheat pancake

 topped with:

• 1/4 tablespoon agave
• 1/8 cup walnuts
• 1/8 cup chopped apple 

I was so excited because I had lots of house work and errands to run. I think it was the egg that held me better, even better than the same amount of protein from yesterday's turkey sausage. I did cut my pancake portion as well, after looking at the amount of food, I knew I couldn't eat it all.  I'm not sure, but after I meet with a dietitian this week, I'll have more direction on this one.  (You can compare yesterday's breakfast menu under the blog entry post:  "one and a two and a three"

I had a lunch date at 1:00 so I needed to make every minute count. I did have a slight drop around 12:30, but since I had already pushed my limit I pulled out my emergency food stash, apple slices and peanut butter. It only took two slices to hold me till l:00 lunch...I call this success, because on an ordinary day I would have made it.  It any day is considered ordinary, that is!

The most important key for me is to find out what foods hold me till the next meal. Before I would unexpectedly drop so low that recovery was difficult and unpleasant.  Taking my blood sugar level at two hours and two and a half hours, I can now tell what to expect.  When I add in exercise I may have to increase the carbohydrates, but for now, I'm happy.  

I will say that my breakfasts before didn't include pancakes, but I've been wanting them for sometime now. Regular pancakes make me "feel bad" I guess because it makes my blood sugar go up too quickly.  So I never eat them. I'm trying buckwheat. My pancakes were homemade from stone ground buckwheat pancake mix. Because they were made at home, I made "baby ones", just right for me. Next time I'm going to try crepes instead. 

Buckwheat is actually not part of the wheat family. It is a gluten-free grain and it's low glycemic. Buckwheat is a member of the grass family whose seed is high in calcium. Normally thought of as a cereal, buckwheat is actually an herb. This crop is generally grown without herbicides and pesticides. 

Now that breakfast has a few good options of choice, I'm hopeful.  At least I have one full days menu of three meals and snacks worked out.  I'll post that later...look for a new and upcoming topic about menus for hypoglycemia...stay tuned.

Yes we can we have many more "meals" to go!

If you're not suffering from hypoglycemia, this post might just drive you a little crazy, as I'm exploring and experimenting with my meal options to keep my blood sugars level.  

Hypoglycemia among RNY patients 2 to 3 years after surgery seems to be more prevalent than I first expected and there seems not be a simple solution, so if you'll bear with me, this is one phase of the journey in which you have a front row seat.  I'm determined to find answers without having any more vital organs removed.  

In all seriousness, if I can fix it with my diet, I'm determined to do it, even if it takes awhile.

My objective in journaling and sharing these post are maybe to help others in this situation find solutions or at least help others avoid the problem altogether.  

So I'm being very transparent about my diet and about what works and doesn't work for me.  Key words here are: "for me". Everyone is different and you must find what works for you.  With that said, let's find out together if we can be part of the solution. 

I've decided to put "weight loss" thoughts and exercise efforts on the back burner for a bit, until I can find out how to stabilize my insulin levels.  Right now any activity beyond making the bed is over the top.

This is not a laughing matter, but I've decided to make it a little more palatable, I'll throw in a little humor!

So, here's what's on my mind. Yes, it was Pippin in the Lord of the Rings who said: “We've had one, yes. What about second breakfast?” So these days I have followed the "Pippin way" and adopted second lunch.  I'm trying also to coin a phrase for second lunch, but it just hasn't hit me yet.  

If I had a morning snack, I could call it elevenses which is an old fashioned English term for eleven o’clock. Which in most cases is more like my lunch. I like to eat around 11:30, but sometimes it's more like 12:00-12:30. Maybe I could call my afternoon meals "three-zes" because my second lunch is around 3:00 in the afternoon, and it is my third meal of the day. I don't know, what do you think? 

However, at this stage of the game, not quite figuring out how to make it till three o'clock, maybe I should name it two-zees, because not only do I have to eat a 2:00 second lunch, that would also put me eating every two hours and since I'm eating two or three meals after lunch, one of these names would be suitable. 

I could name this phenomenon after Pippin and call it "pippins".  That might sound a little crazy, but I am a little "crazy" at this point.

OH...do I need help!

I'm either going crazy or I've regressed to the world of a two year old.  Which starts me thinking since I'm already on the precipice, I might as well jump...forget it all and eat whatever.

Somehow, I'm not sure that would work either, or would it? 

Maybe I do need a mental examination!

I guess you have realized by now that I'm a little frustrated...breakfast didn't get me through to lunch, so after 2 1/2 hours  and a morning of house work, I had to look food.  I did try something new so may I need to reconsider my choices and decide what I could have done differently.

Breakfast  (Don't try this at home...yet)

• 2 Turkey sausage patties
• 1 half buckwheat pancake
• 1/8 TBsp almond butter
• 1 teasp molasses drizzled on top

After breakfast I had so much energy, I felt great, at the two hour mark, all was well...just like yesterdays meals, but between 2 and 2.5 hours, I start to drop, rapidly. At this point the question is: Am I eating wrong, or not enough, or will I just have to eat every two hours?  Boy, I thought eating every three hours was a lot!

I usually can't eat pancakes, at all...especially white flour ones and never with maple syrup.  That is a for sure blood sugar killer.  I was hoping the buckwheat (small size) would work with the nut butter.  It did fit within the limits of the low fat, low carb, low sugar and protein levels guideline, which not I'm thinking isn't enough for me.  Maybe I should have had a different protein or less pancake, or maybe an egg and 1 sausage.  I'll try again and see what happens. 

OK...so I grabbed a piece of cheese and headed off to pick up my grandson.  We went to our favorite place for lunch, that is regular lunch.  Moe's.  Well, after looking at the number of folks in line, I decided I needed a glucose tablet...especially with having a two year old in-tow.

I can always trust that when I eat at Moe's I'll make it for longer in the afternoon without sugar drops... here's what my regular menu looks like at Moe's.  

Lunch  (this one works for sure)

Welcome to Moe's

a moo size naked burrito...which translated is a burrito with no flour wrapping and the moo size is the kids sized meal. I order it -naked- which means - in a bowl.  The serving size is about:

• 1/4 to 1/3 cup black beans
• 1 to 2 ounces ground beef
• tomatoes
• and jalapeno slices
• 1 tbsp sour cream on the side 
• 1 tbsp queso cheese on the side
• 8 to 10 tortilla chips

Sure enough, my blood sugars made it past the two and half mark today, but since dinner will be late because of a dinner engagement, I'll have to eat something to hold me till dinner.  We are suppose to meet at the restuarant at 7:00, you know what that means, dinner probably won't be served till closer to 8:00, that would be my after evening meal and would equal "for me" skipping a meal time, so I'll just have to eat a before dinner meal tonight. 

I'm tired just thinking about all this checking blood sugar levels, eating and calculating...as I'm sure you're tired of reading it...hope I find a solution soon...

So until next time...whether you’re eating breakfast, second breakfast, elevenses, brunch, lunch, afternoon tea, two-zees, three-zees, dinner, or supper…or even"pippins" if you please, make it healthy and happy. We have many more miles to go!

Hypoglycemia after weight loss surgery is a scary thing. At the time of this post, I have been battling this for a year now.  Sometimes, I am perfectly fine, other times I "crash and burn" with apparently no reason.  

I say "apparently" because I didn't drastically change my eating, but maybe I varied off course just enough to make a difference in my insulin levels.  

Or it just maybe that after a year or two out from surgery your body changes.  It is possible that we just don't know what causes hypoglycemia after weight loss surgery. Except that the underlying problem is insulin levels.  Not everyone's body reacts the same. But whether you become lactose intolerant or struggle with hypoglycemia, either way, (to my untrained eye) it is a sugar problem...Sugar...it's always the culprit, isn't it?

In all fairness, to those who have tried everything and still struggle with hypoglycemia, I feel your pain. It's scary and frustrating. I hope this blog helps in some way.  It may not always be what we eat, it may just be our body's reaction to the surgery. For some, diet may help for others it may not be something that we, ourselves can control.  

With that said, let's talk about trying to improve at least what we can control.  I'll use this example, in geometry, a slight change in degree doesn't matter so much in the beginning, but the further out the "line" goes, the further from the target it gets.  I know this principle because I used to play golf. 

Next is what makes or breaks you, putting.  Putting is about geometry, too. When putting, you have to be "spot on", no room for error.  You may start off a tiny bit off-line from the hole, in a short putt, it's no big deal, but the longer the putt, the more off you become.  The longer the putt, the more accurate you have to be.   

So, let's just say I'm re-thinking my approach shots and suring up my putting just a bit. I'm going back to the beginning and trying to figure out what is going on.  If it is from "correct" or "incorrect" eating...I'll see. Otherwise, I'll know it's just a chemical or "internal" problem that can't be corrected with eating.  If I have strayed too much from my original "plan", the movement could be slight, but the longer out you go, say from surgery, slight changes in your body or body chemistry might just cause you to become "off line".  If it's something I can control, I should find out.   

So for those of you who are following my "experiment" with hypoglycemia after weight loss surgery, this is my new plan.

First, back to basics:

refuel:

• priority: protein
• some healthy carbs: whole grain breads, low glycemic fruit and veggies, or beans)
• no refined, white or processed foods, as close to whole as possible
• some fat

regular pit stops: timing:

• eat meals, not snacks
• eat at regular intervals (3- 3 1/2 hours, no longer)
• which means, make sure I get enough protein with the mid-afternoon meal/snack 
• don't delay or skip meals (including the in-betweens)

the test:

• Follow these rules and see what happens. 
• Keep check on blood sugar 2 hours after eating.  

Today's breakfast was eaten within an hour after waking.

• 1 fried egg
• 1 piece turkey sausage
• 1/2 slice Thomas mini whole wheat bagel
• 1/2 tbsp real butter 

I'll let you know how it goes. 

I'll be adding to these post as I go along.  

Yes we can, we have many more miles to go

You get to be in on an "experiment" in progress!  One with my blood sugar battle, as I discover how to stop the low sugar levels 2 hours after I eat, which is affecting my activity and my weight.  

The "race" against the food item I eat and the clock!

Ladies and gentlemen...start your engines...it's off to the races. It's time to "test" drive my research. 

Yea! It's time to talk about carbohydrates! 

I bet you thought you would never eat them again!

Well, think again! 

It might be that we just need to know some information about how carbs work in our body, which ones are best, how to eat them.  

The food experts (who ever they are) used to classify carbohydrates into categories such a simple and complex. Today after more research on how these carbs react with in our bodies, that language has changed.  It is now referred to as the glycemic index or glycemic load.

The glycemic index is referred to as the GI and is the measure of the rate at which a carbohydrate will enter the bloodstream as glucose and effect your blood sugar.  It's an indicator of the ability of different types of foods that contain carbohydrate to raise the blood glucose levels within 2 hours. Foods containing carbohydrates which break down most quickly during digestion have the highest glycemic index. 

Another measure that more accurately represents the blood sugar impact of carbohydrates takes into consideration serving sizes and also takes into consideration the entire meal this is defined as theglycemic load or GL.  It more accurately represents the impact of carbohydrates because it takes into consideration the rate of absorption of sugars into the blood stream. 

In other words, you could still eat a high glycemic index food in smaller amounts and in combination with other foods which will slow the absorption rate.  Now this all sounds very complicated, but I've been doing my research...and I am going to give it a whirl, (once around the track) to see if it helps regulate my blood sugar drops.  So far so good. Within the last three days, I have been more stable and have amazing dropped the five pounds from last week when my blood sugars were out of control. Some days I have eaten more calories and carbs that I was eating before! Go figure!

At this point it's more about my blood sugar levels and not the weight, however is is frustrating to gain when you are supposedly doing everything "right". The test for me is the dreaded two hour mark after my meals, or during more actively or exercise, will I "crash and burn"?  We shall see.  

It's really been simple, so far I've just substituted a few carbohydrate food items in my diet. Now, keep in mind RNY patients have a different configuration going on "under the hood", so we have to line this up first with our bariatric needs.  The same rules don't apply as to non-bariatric patients, there are just a few "bariatric" guidelines to add into the equation.  

I've notice that sometimes certain foods don't "crash" my sugars when I thought they would, and other foods do when I eat them alone, instead of with a protein.  If it works, I'll be sharing more during the upcoming post, so stay tuned.  Search for more on this topic under the titles listed below as well as the series named: Start Your Engines

Yes we can, we have many more miles to go!