Nutrition Tip of the Week

Author: Nadea S. Minet, MS, RDN, LD

Week of August 5, 2013

The Deal on Dumping Syndrome

You just had few bites of ice cream because you were at a birthday party and saying no was not an option this time.  About 45 minutes after these delicious few bites, you start to feel dizzy, a bit of disorientated, a panic starts to take over your mind and body.  Then you begin to sweat profusely and now your shirt and hair are completely soaked.  Your skin is glistening and sweat is dripping on the floor.  During this state of sweaty panic, you feel like you have lost your mind.  The state of distress is so severe, you are not sure what to do next: lie down, start pacing, sip some water, or eat something real quick.   What could possibly have happened to you? Is this what dumping feels like?  Although each person experiences dumping syndrome differently, here are the basics.

What is Dumping Syndrome? Dumping syndrome is a group of symptoms that are most likely to develop if you had surgery to remove all or part of your stomach, or if your stomach has been surgically bypassed to help you lose weight. Also called rapid gastric emptying, dumping syndrome occurs when the undigested contents of your stomach move too rapidly into your small bowel.

What are the Common Symptoms? Common gastrointestinal symptoms include abdominal cramps, vomiting, nausea, feeling of fullness, and diarrhea.  Some people experience cardiovascular symptoms such as flushing, dizziness, lightheadedness, heart palpitations and rapid heart rate.  Most people with dumping syndrome experience symptoms soon after eating, usually within 15-30 minutes.

In others, symptoms may occur 1-3 hours after eating. This is due to the dumping of large amount of sugars into the small intestine (hyperglycemia). In response, the body releases large amounts of insulin to absorb the sugars, leading to low levels of sugar in the body (hypoglycemia). Symptoms of late dumping can include:  sweating, hunger, fatigue, dizziness and lightheadedness, confusion, heart palpitations and rapid heart rate, and even fainting.  Some people experience both early and late symptoms.

Who Experiences Dumping Syndrome? The most common type of weight loss surgery associated with dumping syndrome includes gastric bypass (or Roux-en-Y Gastric Bypass), however some sleeve (Vertical Sleeve Gastrectomy or Sleeve Gastrectomy) patients are now reporting symptoms that appear to be dumping syndrome as well.  Dumping syndrome is not commonly, if at all, reported in band (Adjustable Gastric Band) or switch (Biliopancreatic Diversion with or without Duodenal Switch) patients.  Not all gastric bypass or sleeve patients will experience dumping syndrome.  Talk with your surgeon if you are considering weight loss surgery about which surgery is right for you and your chances of developing dumping syndrome with each procedure.

Treatment Options. If you have signs and symptoms of dumping syndrome, you are most likely to see your primary care physician, surgeon and/or dietitian at the bariatric center.  Most cases of dumping syndrome improve as you learn to eat in a manner that should prevent the condition from occurring and as the digestive system adjusts. There is a good chance that changing your diet will resolve your symptoms. If it doesn’t, your doctor may advise medications and/or surgery to address the problem.

Here are some dietary treatment strategies that your doctor or dietitian may recommend and that you can try on your own. They can help maintain good nutrition and minimize your symptoms.

  • Eat smaller meals. Try consuming about 5-6 small meals a day rather than three larger ones.
  • Keep portions small such as 1 ounce of meat or ¼ cup of vegetables.
  • Everyone tolerates food differently. Avoid the foods you know cause you problems.
  • Avoid fluids with meals. Drink liquids only between meals. Avoid liquids for a half-hour before eating and a half-hour after eating.  Some bariatric programs will recommend this or no fluids with meals or 30 minutes after the meal.  Talk to your surgeon and/or dietitian to learn how they would like to you to consume fluids in regards to mealtime.
  • Change your eating plan. Consume more protein-rich foods such as red meat, pork, fish, and chicken.  Include some fat (healthy fats preferably) with your meal.  For example olive oil, which adds calories, may help dumping symptoms.  Limit your intake of foods and drinks with high sugar content.  Milk contains a natural sugar, lactose, which may cause dumping syndrome depending on the person.  A small serving (½ cup) of milk, cheese, or yogurt is tolerable to most people. Consume more foods low in carbohydrates, such as grains, starchy vegetables and fruits. Avoid foods with simple sugars, including glucose, sucrose, fructose, dextrose, honey and corn syrup. It may help to see a registered dietitian to learn which eating plan strategies are right for you in your progression following weight loss surgery.
  • Chew well. Chewing food thoroughly before you swallow can ease digestion. Cut food into very small pieces.
  • Increase fiber intake. Psyllium, guar gum and pectin in food or supplements can delay the absorption of carbohydrates in the small intestine. Pectin is found in many fruits, such as peaches, apples and plums.
  • Avoid alcohol. Bariatric patients should be cautious with alcohol consumption anyways, but consuming alcohol may also increase your chances of experiencing dumping syndrome.  As we know alcohol is also empty calories and some bariatric patients may experience a “buzz” faster following weight loss surgery.
  • Stay away from acidic foods. Tomatoes and citrus fruits are harder for some people to digest.
  • Avoid foods that are very hot or very cold. The temperature of your food may trigger dumping syndrome symptoms.
  • Use low-fat cooking methods. Prepare meat and other foods by broiling, baking or grilling.
  • Lie down after eating. This may slow down the movement of food into your intestines.  This decreases the symptoms of dumping syndrome by slowing the emptying of food from the stomach.  However, lying down after meals may increase your risk of acid reflux (heartburn).

Even with dietary changes, you may continue to experience symptoms associated with dumping syndrome.  It is important to manage those dumping syndrome symptoms so you stay well nourished and do not lose too much weight too fast.

Talk to your health care provider about any symptoms you have experienced and what else you can do so you continue to CELEBRATE your weight loss success.

Please Note: Dairy products such as milk, cottage cheese, ice cream, and pudding may cause diarrhea in some people after surgery.  You may need to avoid milk products at first and then try them in small amounts as you advance your diet.

Please Note:  Remember, this blog is not your healthcare provider and is not intended to provide individual medical advice.  Every bariatric patient is different and it is important to seek medical advice from your surgeon, dietitian, and nurses at your bariatric hospital or clinic.

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