Proteins, fats and carbs diet - which is when?

Daytonite, BSN, RN · Mar 23, 2007

to begin with you must understand that one of the functions of the pyloric valve of the stomach is to gradually release the contents of the stomach into the intestines where food absorption occurs. people who have had gastric resections or gastric bypass surgery for the purpose of weight loss no longer have the part of their stomach that has the pyloric valve. what that means is that any food that they eat almost immediately goes into the small intestine because there is no pyloric valve to hold it back anymore. as part of their postop teaching these patients are cautioned about eating foods that are high in carbohydrate content since that food is going straight into their intestine almost immediately for absorption into the blood steam. absorption of glucose occurs in the small intestine.

what happens to a person who has had a gastric resection or gastric bypass is that if they eat a large amount of products that contain a high amount of simple glucose that huge amount of simple glucose is absorbed into the blood stream in the small intestine very rapidly over a very short period of time. imagine your system suddenly taking on 500+ calories in the matter of a few minutes! the pancreas--even a normally functioning one can't deal with that! the result is what has been termed "dumping syndrome". the symptoms are lightheadedness, sweating, nausea, abdominal cramps, weakness, heart palpitations and can also be followed by diarrhea--actually, many of these are the same symptoms of hyperglycemia. these symptoms will persist until the pancreas can "catch up" and put out enough insulin to get the blood sugar levels down to normal.

carbohydrates also have glycemic indexes. that means that certain carbohydrates break down into simple glucose faster than others. certain fruits and vegetables like broccoli, celery, grapes, lettuce, onions, pears, apples or tomatoes are good sources of carbohydrates that have low glycemic indexes. foods with refined sugar like cakes, cookies, milk chocolate (all the stuff we love!) are high on the glycemic index and give up their glucose readily and quickly. this is why you would give a person who is hypoglycemic a glass of orange juice--because they will absorb the glucose and bring their glucose level up rapidly. large amounts of these high glycemic index foods are no-no's for people that are at risk of getting dumping syndrome. it doesn't mean that they can't ever have them, but they can't have large amounts of them at one time. i know several people who have had gastric bypass surgery. they can eat candy, but only a few bites or, look out, dumping syndrome, and boy! can they get sick with it. one of my relatives had gastric bypass surgery and i saw him break out into a sweat and have to lie down because he got sick after eating a bunch of cookies (old habits die hard). he won't be making that mistake again.

any resulting diarrhea is because of an overly large amount of sugar that got put into the intestinal track at one time and couldn't be processed and absorbed. undigested sugar has a high osmolality and it will pull fluids into the bowel with it, thus resulting in diarrhea. this is the same mechanism behind lactose intolerance (the person lacks the enzyme to break down the lactose into glucose) and what can happen if you eat too many sugar free candies at one time. the sugar free candies have sugars in them that our bodies cannot metabolize because we do not have the necessary enzymes to do so. these sugars have nowhere else to go and must continue to make their way through the intestinal system until they come out the other end. if you eat too many of these sugar free candies at one time you will get diarrhea because of the osmotic effect of the "unfriendly" sugar as it makes its way through the intestinal system pulling fluid into it as it traverses its way toward the rectum. it warns you of this on the package. sorbitol, one of these sugars we cannot digest, is an ingredient in a prescription laxative on the market today in a controlled dose to produce bowel evacuation.

the zone diet is really good about listing low carbohydrate foods. what are listed on its favored or favorable carbohydrate lists are low glycemic index carbohydrates. anyone who is dieting or has had a gastric resection or gastric bypass surgery should be able to eat reasonable amounts of these carbohydrates fairly safely without raising their blood glucose levels too rapidly or getting dumping syndrome from pouring too many glucose calories into their intestinal tract too fast. the weight watchers diet currently supports similar lists. the old weight watchers diet and even the old richard simmons diet had a list of "free" foods that you could eat all you wanted of and still lose weight. many of them were fruits and vegetables that are now known to have a low glycemic index which is why you could eat tons of them and still lose weight. they have no or are very low in calories, or usable glucose by our bodies.

hope that helps explain dumping syndrome and why it occurs as well as why people can get diarrhea with dumping syndrome and with lactose intolerance or eating too much sugar free candy. it's all kind of related.

Daytonite, BSN, RN · Mar 23, 2007

I forgot to add that the reason that gastric bypass patients are told to eat high protein diets (not so much high fat) is because they need the protein. We all need a benchmark amount of protein every day. We do get some caloric value from the proteins and fats we eat, but only after the body has satisfied its daily requirement for the protein and fat it needs first. If we do not eat enough protein and fat, our bodies will rob it from the body itself. That's not good. The protein of our body is tied up in muscle and many other tissues. We need those structures!

The reason high protein diets work for weight loss is this. The protein the person eats keeps the body from robbing itself of its own protein stores. Because you can't eat enough protein to sustain the calorie requirements you need, the body will go to the fat stores of the body and start metabolizing them if no other carbohydrates are around. So, on diets, like Atkins, people can lose a lot of fat very rapidly.

Nuieve · Mar 23, 2007

Wow, Daytonite, I can't stress enough how much I appreciate your time and effort taken to write such a great explanation. It's basiclaly a separate science article, very well laid out and very easy to understand. Thank you very much!!! :)

Daytonite, BSN, RN · Mar 23, 2007

thank you. i wrote it while i was watching my two soap operas. do you understand it though? because toward the end i was getting involved in sonny corinthos doing his thing on general hospital! i never much understood dumping syndrome either until some people in my family and in-laws of my family suddenly started having bypass surgeries to lose weight. i had never realized the importance of that old pyloric valve. without it, life can be miserable if one doesn't follow doctor's orders.

Nuieve · Mar 24, 2007

thank you. i wrote it while i was watching my two soap operas. do you understand it though? because toward the end i was getting involved in sonny corinthos doing his thing on general hospital! i never much understood dumping syndrome either until some people in my family and in-laws of my family suddenly started having bypass surgeries to lose weight. i had never realized the importance of that old pyloric valve. without it, life can be miserable if one doesn't follow doctor's orders.

amazing, i guess those soap weren't really interesting if you could focus so well to lay out your thoughts this way. i think i understood the diet for dumping syndrome very well, i think to put it shortly, the body can't tolerate large amounts of carbs at once, especially those with high glycemic index, they should be limited just to the amount patient can tolerate well (which is actually still pretty low), and high amount of fats is provided to compensate for the lack of carbs (as an alternate energy source) since high amount of fat doesn't cause too many problems... ketosis probably can occur, but i think if we add fluids to wash them away the patient will be more or less alright... did i get it right? :)

Thedreamer · Mar 24, 2007

Wow thank you SO much for that. I am actually learning about the GI and all these things right now in my term 3 clinical. We are focusing on GI and Dx, Sx, Meds ect.

Dumping syndrome as explained in my book is about 3 sentences. You TOTALLY made my day with this post. I luff you!!!

- ian

Daytonite, BSN, RN · Mar 24, 2007

amazing, i guess those soap weren't really interesting if you could focus so well to lay out your thoughts this way. i think i understood the diet for dumping syndrome very well, i think to put it shortly, the body can't tolerate large amounts of carbs at once, especially those with high glycemic index, they should be limited just to the amount patient can tolerate well (which is actually still pretty low), and high amount of fats is provided to compensate for the lack of carbs (as an alternate energy source) since high amount of fat doesn't cause too many problems... ketosis probably can occur, but i think if we add fluids to wash them away the patient will be more or less alright... did i get it right? :)

actually, i saw less of the soap opera than i suggested since i was really concentrating on the reply to this thread. i shouldn't make myself sound smarter than i really am. anyway, yes, you have it right, except i'm not so sure about the high fat content in the diet. most professionals aren't happy about high fat diets. for one thing, they put a real strain on the gall bladder. for another, they tend to raise cholesterol levels in some people. another is that they can cause problems with steatorrhea in some people. a sufficient diet of calories can be maintained with low carbohydrate foods and low fat diet.

i think there is a lot of variability as to what individuals are able to tolerate once they have had gastric reconstructions or gastric bypass. i've seen one lady who gets sick on two swigs of real pepsi (the one with sugar in it, not the diet stuff) and another who munches on doritos all day long as he drives his truck across country and throws down milk shakes here and there for something to drink and claims he never gets dumping syndrome. both had gastric bypass surgeries. why they react differently, i don't know. maybe their physiology is different; maybe their surgeries were slightly different; maybe one is lying; i don't know. i do know that a milk shake is loaded with calories and most gastric bypass patients cannot tolerate any large amounts of ice cream products because of high sugar content in them. but, the theory behind all this is correct. perhaps some members who have had gastric bypass or know of people who have had gastric bypass or gastric resections might comment on this as well.

Nuieve · Mar 24, 2007

actually, i saw less of the soap opera than i suggested since i was really concentrating on the reply to this thread. i shouldn't make myself sound smarter than i really am. anyway, yes, you have it right, except i'm not so sure about the high fat content in the diet. most professionals aren't happy about high fat diets. for one thing, they put a real strain on the gall bladder. for another, they tend to raise cholesterol levels in some people. another is that they can cause problems with steatorrhea in some people. a sufficient diet of calories can be maintained with low carbohydrate foods and low fat diet.

no no no you didn't. :) i was just really grateful that you took your time from what you've been doing to help me with that. to be honest i too feel a bit vague about what good can high-fat diet do to any patient at all... but it does get mentioned in treatment plans a lot. i think it's always safer to stick to moderate to low fat levels in the diet... unless someone's dangerously skinny and needs to put on some weight quickly :) (which is too, not really the best way, but...)

llg, PhD, RN · Mar 24, 2007

Don't forget to consider that the different types of fats have very different effects on the body. Vegetable fats (such as olive oil and canola oil) and fish oils are very different that the most of the animal fats.

Tweety, BSN, RN · Mar 24, 2007

Wow, Daytonite, I can't stress enough how much I appreciate your time and effort taken to write such a great explanation. It's basiclaly a separate science article, very well laid out and very easy to understand. Thank you very much!!! :)

Daytonite rocks!

SummerGarden, BSN, MSN, RN · Mar 25, 2007

Daytonite rocks!

Yes, she does! Dumping Syndrome was mentioned in 2 seconds in a lecture my class had on Nutrition. A student asked for clarification, but none was really given! After reading this thread I now have a better understanding!

Keep up the good work, Daytonite!