NBME 20 Starchy foods (NBME Answers)

Retired NBME 20 Answers

nbme20/Block 4/Question#44 (reveal difficulty score)
A 45-year-old man comes to the office for ...
Starchy foods 🔍 / 📺 / 🌳 / 📖
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+4 upvote downvote
submitted by ∗thepacksurvives(21)

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I think this one has to do with "late dumping syndrome"-- basically, starchy foods cause hyperglycemia --> release of insulin --> catecholamine surge --> diarrhea, etc.

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smc213 https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=134&ContentID=107 +

merpaperple It's not necessarily late dumping syndrome, this is the dietary guideline for early dumping syndrome too. Based on UpToDate and ScienceDirect this is how it works: Absent or dysfunctional pyloric sphincter -> food is rapidly emptied from the stomach into the small bowel -> hypertonic solution forms in the jejunum -> rapid fluid shifts from the plasma into the bowel -> hypotension and SNS response (eg. colicky abdominal pain, diarrhea, nausea, tachycardia) Simple carbohydrates are more hypertonic, I think. https://www.sciencedirect.com/topics/medicine-and-dentistry/dumping-syndrome +5

j44n starches are complex carbs= more than 2-3 sugar molecules, if they have dumping syndrome they have decreased gastric transit time= more undigested carbs are delivered to the intestines and that gives you more carbs for bacteria to break down (flatulence and osmotic diarrhea) +

This video makes sense https://www.youtube.com/watch?v=mXhNYj_oqEU

+/- uasid(68)

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submitted by ∗beeip(141)

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Thought this would be something regarding "bariatric surgery," but nope, just "no starchy foods, because you're pre-diabetic."

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hello Yep, seems that because the patient has prediabetes, he should avoid eating excessive starchy foods. +

yotsubato such a BS question IMO +7

yotsubato such a BS question IMO +

breis I put nuts thinking of "fats" and that with a bariatric surgery they may have problems with absorption.. +6

teetime This isn't right because the bariatric surgery will cure the prediabetes. It's dumping. +2

dr_jan_itor Why should he avoid eating excessive starchy foods? To avoid gaining weight? It doesn't matter what macronutrients he eats if they are calorie controlled. +2

dhkahat yeah but he's prediabetic. you want someone like that to shove a bunch of starch down all the time? +

+1 upvote downvote
submitted by ∗strugglebus(189)

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I had put "starches" b/c pts that undergo bariatric surgery are only supposed to eat complex carbs (fruits/vegetables) and avoid simple carbs (i.e. breakfast cereal/baked goods)

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+0 upvote downvote
submitted by ∗brise(86)

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https://www.pennmedicine.org/updates/blogs/metabolic-and-bariatric-surgery-blog/2020/january/foods-drinks-to-avoid-after-bariatric-surgery#:~:text=Diet%20after%20Bariatric%20Surgery&text=After%20protein%2C%20focus%20on%20non,may%20not%20be%20well%20tolerated.

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brise "Starches such as fried potatoes, rice and pasta may make you feel bloated or gassy and may not be well tolerated." +

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submitted by ∗topgunber(68)

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damn, i was way off. i put green leafy vegetables thinking the increased folate content can cause bacterial overgrowth. pretty sure i had a uworld question that said something like that.

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bgreen27 I was thinking the same thing! I was thinking the same thing! RYBG (a type of gastric bypass) can cause small intestinal bacterial overgrowth (SIBO) increased growth in the blind pouch segment. SIBO results in deficiency of most vitamins (B12, A, D, and E) and iron, BUT increased production of folic acid and vitamin K. -Uworld +1

bfinard1 Any idea why this isnt the case? +

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submitted by ∗garima(21)

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Because of the starchy nature of bread, rice, and pasta, after your surgery, they can form a paste in your throat that is hard to swallow without liquid. In some cases, they can block the stoma, the hole to the pouch that is your new stomach. You don’t have to completely reject these high-starch foods, but it’s best to avoid them in the beginning. When you do eat them, try to have very small portions and make sure that you only eat small bites of each.

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-3 upvote downvote
submitted by ∗humble_station(85)

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I think it has to do with the surgery. Getting a gastric bypass or bariatric surgery means you no longer allowing contents to pass through the duodenum. So that would mean if you had a starchy meal you would not be able to release the appropriate enzymes from the pancreas to allow for digestion.

Please correct me if I'm wrong!

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