A slow wave of heat starts to overcome my body. It’s an inner fire that burns from within and spreads outward. Its onset is somewhat insidious. At first glance it may appear it’s the ambient temperature which has changed, but soon it becomes clear the heat is from within. As if my body wants to quench the inner fire, it starts to sweat. Beads of salty water begin to form on my face, neck and chest. The small beads of sweat coalesce into larger beads and at a certain point the beads begin to slide down my skin under the unavoidable pull of gravity, drenching everything in their path.

Given my age, there have been a few times I have thought this must be the beginning of menopause. From what I’ve heard woman describe, the feelings and sensations are similar. It is not however menopause, because after a few minutes my heart will start to race. I can feel it beating strongly, thumping on my chest wall trying to break out. This sensation is followed by nausea. Sometimes it’s a small twist and turn of a phantom stomach. Other times it is so intense my mouth begins to fill with saliva, the body’s natural way of lubricating the system before vomit starts to rise. I have gagged, and swallowed it down refusing to give into the sensation. Refusing to vomit. How would I do that anyway? How does one vomit without a stomach? I know people can do it, and have done it, but I hope I never find out, although it is foolish to think it will never happen to me.

If I am lucky, all these alien like sensations will stay for 30-40 minutes. If I rest and relax and lie back, under a fan trying to quell the fire and ignoring the sensation of nausea, it will go away. If it’s bad, the cramping from where my stomach should have been will flow downward to my bowels. They squirm and move as if on fire themselves pushing out what ever toxic substance is invading them. 

This is not menopause, or food poisoning, but rather dumping syndrome. The offending toxic substance my body wants to reject is sugar. The onset, unfortunately happens about 10-15 minutes after the sugar has been ingested. Dumping syndrome is my body’s strange response to sugar. Actually, anyone who has had gastric bypass, or a total gastrectomy, will fall victim to the sweet temptations and vile repercussions of sugar. Sadly, dumping syndrome is not limited to sugar alone and can also be trigged by fatty foods and sometimes, to a lesser extent, excessive carbohydrates (carbs).

Yummy organic turbinado sugar

Since my surgery I have been conducting various experiments on myself in an attempt to find what is palatable, what will provide me calories, and what will not cause dumping syndrome. It has not been easy. I have the guidance of a dietitian and medical knowledge, but it only gets me so far. The only way to really know what will work is by trying things. I have yet to really have a day without some varying degree of dumping. The dietician says to eat dairy because it’s packed with protein. I’ve said this before, but I’m not a diary person, however given that I need to get calories in my body, I continue to try to tolerate it. Cottage cheese. Completely and utterly disgusting without honey and fruit. Yogurt. I can tolerate some brands with very low sugar, but have found yogurt is best tolerated in the afternoon and evening. Not the morning. For whatever reason after an overnight fast, yogurt is the worst. I could go on and on and about what I am eating and trying, but the point I’m trying to get across is that I have been conducting pseudoscientific food experiments on myself daily. It makes me feel a bit mad at times, in my lab (kitchen) concocting the next dose of medication (meal) I will try, taking notes as to what affects me how and when it affects me most.

The real reason you clicked on this link is because it said something about sugar and had a nice instagram worthy picture to go with it. Tricked you. This post is all about dumping syndrome. So what the heck is that anyway? To put it is the simplest non medical terms, it goes like this. When a normal person has a stomach, they chew their food and swallow. The food goes into the stomach and there the food is further churned into a lovely paste called chyme. Sounds yummy right? While undergoing this process, the food is being mixed with the hydrochloric acid your body makes. This acid and some other stuff your stomach makes start to break down the food, that way then the chyme (food paste) is pumped out of the stomach into the duodenum (first part of the small intestine), is partially processed and digested. That’s exactly how the duodenum likes it. Here the pancreas releases some serious digestive enzymes and your body senses and releases insulin in response to the food that is coming through. Insulin helps bring the food (sugars) into the cells where it is used for energy. This is the whole reason we eat, to get energy for our cells. It’s a well coordinated system that has worked for a millennia. 

So what happens when you don’t have a stomach? Well, you still eat, except now you have to chew your food to a paste since your stomach can’t do that job for you anymore. Also, since you don’t have a stomach you don’t have the acid to help start breaking down the food. Because you are now stomachless, when you swallow your now well chewed food, it goes straight from the swallowing tube (esophagus) into the duodenum. The duodenum up until your gastrectomy has been living a posh life. It has been handed well prepared food (chyme) in small portions. Now all of a sudden it is being handed large boluses of food which are not partially digested by the stomach acid. The most offending agent to the duodenum is sugar. The sugars get into the duodenum and the duodenum says “What the heck is this___?!” Throw in whatever descriptive expletives you would like, but you get the point. The duodenum was not ready for this. Prior to the surgery the duodenum had been living a life full of well crafted meals, a fine dining experience if you will, and now all of a sudden it’s been handed fast food. It doesn’t know what to do. It says, “I’m going to get this ___ out of me! It’s too sweet!” How does the body do this? Simple. It dilutes the food and does so by pumping a bunch of water into the duodenum trying to flush the food out. The problem is when the body dilutes this food slurry, its got to go somewhere. Your body doesn’t want it to stay around, it wants it out. One could postulate this is an evolutionary adaptation to help get rid of the poisoned food you just ate, however in this instance, it is just regular ole food. The duodenum having lived it’s snobby life of luxury is too good for this new style of food it’s been given and just like any kid who’s a picky eater, it tries to get rid of what it doesn’t like. This is why you also feel nauseated. When dumping syndrome starts, aside from the nausea, you can also be crampy and if your lucky (insert sarcasm) you get diarrhea. Not only that, but the pancreas says “Oh shoot! I have all this sugar in here, I need to do something about it!” So it dumps a bunch of insulin into your system at once. That’s where the sweating (diaphoresis) and fast heart rate (tachycardia) come from.

For whatever reason dumping syndrome usually only happens with added sugars, some fruits foods which are high in natural sugars, fatty foods and in my case, meals with a lot of carbs. What this means is you, and by you I mean me, have to eat a low fat diet that is high in protein, low in carbs and has zero added sugars. Let me just interrupt this blog to say, that I’m a doctor, but not your doctor, so you should eat what your doctor tells you. This blog is about what I am discovering I have to eat to survive as a human. Every person is different. This blog if for entertainment (your’s, not mine) only. Okay, disclaimer done. As I was saying, finding a diet that fits all of those check boxes, which is also palatable and gives me enough calories to survive has been challenging at best. 

From what I hear, dumping syndrome gets better. It usually only lasts the first year. And I presume there will be a gradual decline in the effects it has on me. I’m going to guess at the one year mark I’ll look back and say to myself, “Oh wow. I haven’t had dumping in a while.” And “Oh, you know what, I can have a little sugar, but not a lot.” It’s not like on August 13th 2020 there will be a switch in my body that gets flipped that says, “Okay, dumping syndrome is done. Feel free to eat anything you want.” If that were the case, I would look for that dang switch now. What needs to happen is my spoiled duodenum needs to get used to its new diet and as it is with all things, it’ll take time and won’t happen overnight. Dang it.