Dumping (gastric) syndrome

[Glassywood]

Suddenly this week my POTS has upped the game. I am 75 years old and have dealt with a multitude of symptoms for a very long time and finally was diagnosed by my cardiologist after failing the tilt table test about 6 years ago. Recently I have been having episodes of what I believe to be dumping syndrome for which I just yesterday realized there was a name. It hits out of the blue with my first feeling quite unwell and very tired. This past Monday after an episode where I am sure my entire colon was totally, rapidly emptied my BP rapidly dropped to 64/50. In all the years of POTS I have never passed out though I have come close. My understanding from my cardiologist is that one does not have to pass out to have POTS. It took several hours for my BP to become “normal” again. I have blamed so many of my symptoms on the fact that until my cardiologist put me on very low dose trazodone, I have survived on rarely more than 3 to 4 hours of sleep. I am EXTREMELY medication sensitive so always refused meds. The low dose of trazodone, 1/2 to 1/3 of a 50 mg tablet) has indeed helped me sleep though the side effects so far are not pleasant. But real sleep is incredible. I would find it helpful if anyone else has found anything that prevents or even helps with this awful dumping syndrome. Thank you very much. Diner.org has been a huge help in educating me and my husband.

[Rexie]

The Trazodone may be causing your symptoms. It is known to cause diarrhea and low blood pressure, as well as serotonin syndrome and hyponatremia (low sodium), along with other side effects. 
In older people, drugs often linger in our bodies longer than in younger people and this increases the risks of side effects. 

There are many other things that might help you get more sleep. You might even find an herbal remedy that works as well or better than the Trazodone. 

Sleeping was an issue with me. Now I like to take ashwagandha (660 mg pressed root powder) with slippery elm (400 mg, for digestive health) before time to sleep, sometimes with chamomile tea (it’s almost as good as a Xanax). This program has added several hours of nice sleep time to my nights with no side effects. If I get up to pee or get awakened, I can go right back to sleep which wasn’t always the case before herbs. 

I hope you find the information and sleep you need! 

Trazodone, Oral Tablet, Healthline: https://www.healthline.com/health/drugs/trazodone-oral-tablet

Dumping syndrome, Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/dumping-syndrome/diagnosis-treatment/drc-20371922

Hyponatremia, Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/hyponatremia/symptoms-causes/syc-20373711

Serotonin síndrome, Mayo Clinic: 
https://www.mayoclinic.org/diseases-conditions/serotonin-syndrome/symptoms-causes/syc-20354758
 

[Glassywood]

Thank you, Roxie.  I began the trazodone after the dumping episode so the drug was not the issue. I have had “dumping” several times before and when I was not on any pharmaceuticals.  I am so extremely medication sensitive that the only thing I take is synthroid for hypothyroidism. I appreciate your info on the herbals. Thank you also for the website info. May I ask how your sleep was before you began the herbals, in other words how many hours a night on average. Glad you have found something to help you. Pleasant dreams!

[Rexie]

Well Glassywood, not your Trazodone. Good to know. 

I use to sleep 3-4, sometimes 5 hours and now sleep 6-7 hours (have gotten 8 and 9 hours a few times) with just one wake-up and that's very nice. 
Too much intestinal and bladder sensation at night and in the early morning use to interfere with my sleep. Now no matter how I feel or how late I stayed up, my pets often insist I get up at the crack of dawn. 

The Slippery Elm (Ulmus rubra) inner bark may still be a benefit to you along with probiotics that contain Lactobacillus and/or Bifidobacterium to help produce GABA (gamma-Aminobutyric acid), our main inhibitory neurotransmitter. It helps create a better balance between the sympathetic and parasympathetic nervous systems. Unlike the upper gastrointestinal tract which is controlled in part by the sympathetic nervous system, parasympathetic neural innervation to the colon plays a significant role in regulating propulsive colonic motility, particular prior to defecation. Damage to parasympathetic nerves, or extrinsic denervation, frequently results in dysregulated colonic motility such as you are experiencing. 

Slippery Elm causes reflex stimulation of nerve endings in the gastrointestinal tract and at remote locations (respiratory and urinary tracts, mouth, etc.) leading to increased mucus secretion and less internal dryness. It is used in a wide variety of gastrointestinal conditions, especially disorders of the lower digestive tract (e.g. colitis, peptic and duodenal ulcers, diarrhea, gastritis, IBD, hemorrhoids, anal fissures), and any condition involving inflammation in the digestive tract. Slippery elm is FDA approved as a safe nutritive. It can be taken with anything else you might be using. 

With regard to ashwagandha and chamomile and the resulting increase in GABA, there is a reciprocal influence between the gastrointestinal tract and the central nervous system which is sustained by the enteric nervous system. GABA is located throughout the gastrointestinal tract and has been localized in enteric nerves as well as in endocrine-like cells implicating GABA as both a neurotransmitter and an endocrine mediator in the gastrointestinal tract. 
GABA is also effective in lowering the blood pressure of hypertensive patients, reducing psychological stress, and shortening sleep latency (time to get to sleep), among other health benefits.

Passion flower (Passiflora incarnata) is another good herb that also increases GABA; it is used a sleep aid.  

GABA is also found in many foods and drinks.  See: 

GABA, a non-protein amino acid ubiquitous in food matrices, Ramos-Ruiz, Roberto, Poirot, Emmanuel, Flores-Mosquera, María, Yildiz, Fatih (editor), Cogent Food & Agriculture, Vol. 4, Issue 1; 2018 
https://www.tandfonline.com/doi/full/10.1080/23311932.2018.1534323 

I'm also drug sensitive and usually require less of many things or can't tolerate them at all. If you elect to try ashwagandha or passion flower, you might start with half doses or drink half a cup of chamomile tea at first.