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NBME 20 Answers

nbme20/Block 4/Question#44

A 45-year-old man comes to the office for ...

Starchy foods

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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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submitted by beeip(65),

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

hello  Yep, seems that because the patient has prediabetes, he should avoid eating excessive starchy foods. +  
yotsubato  such a BS question IMO +3  
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.. +2  
teetime  This isn't right because the bariatric surgery will cure the prediabetes. It's dumping. +1  
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. +1  

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)

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!