Dumping Syndrome

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Dr. Joshua Long

MD, MBA, FACS, FASMBS

What is Dumping Syndrome?

Dumping syndrome (or rapid gastric emptying) is a common side effect of gastric bypass surgery (but not other bariatric surgeries). Symptoms include diarrhea (dumping), abdominal cramps, vomiting, and fatigue and dizziness after eating foods containing sugar. Dumping syndrome is almost always caused by eating too much sugar, too many high-fat foods, or sometimes by eating too quickly after surgery. It can usually be treated by avoiding the sugary foods that cause it, and also by increasing the fiber and protein in your diet.

Dumping can be early or late stage. Early stage dumping syndrome generally consists of cramping or abdominal pain, diarrhea, sweating or feeling flushed, and nausea or vomiting. Early stage rapid gastric emptying happens about 30 minutes after you eat. It is caused by highly concentrated sugars rapidly emptying into your small intestines and drawing large amounts of water out of your body. Avoiding sugar is the key to avoiding most early dumping syndrome.

Late stage dumping syndrome, which occurs 1 to 3 hours after eating, consists of hunger, fatigue, dizziness and lightheadedness, and feeling like your muscles are made of jelly. It is caused when sugar makes your body produce too much insulin, which drives your blood sugar down below normal levels. Again, the key to avoiding late dumping syndrome is to avoid sugar or high-glycemic-index foods and increase your dietary fiber content.

Early Stage Dumping Syndrome

Early stage rapid gastric emptying is caused by eating foods that go against your post-bariatric-surgery diet, such as sugar or fried foods. If you suffer from early stage dumping, about 30 minutes after your meal you may experience the following dumping syndrome symptoms:

What Causes Early Stage Rapid Gastric Emptying?

Early stage dumping is usually caused by either eating your food too quickly; or eating foods that are high in fat, sugar, or simple carbohydrates (such as white bread).

Eating too quickly: After gastric bypass surgery, your stomach will no longer regulate how quickly food passes out of your stomach and into your small intestine. This means that when you eat large bites, eat too fast, or drink liquids close to meal time, food can pass out of the stomach and into your small intestine too quickly.

Eating the wrong foods: After gastric bypass surgery, food empties into your intestines before your digestive juices enter (they are delivered about 3-5 feet downstream) meaning that part of your small intestine does not metabolize food. This decreases nutrient intake, and is an important mechanism for lasting weight loss. But the small intestine receives food before the digestive juices can help to metabolize sugars. When you eat sugar (in some cases, even sugar from fruit), it passes into your lower intestine without being fully absorbed.

Your body responds to the undigested food being “dumped” into the lower intestine by shifting fluid into your intestine to dilute this sugar. This is what causes symptoms like bloating, cramping, and diarrhea, as well as dizziness.

Most patients who suffer from dumping syndrome suffer from early stage rapid gastric emptying.

Late Stage Dumping Syndrome

Late stage dumping syndrome is your body’s second reaction to the food being “dumped” into your small intestine, and affects patients 1 to 3 hours after they eat. Late stage symptoms include:

What Causes Late Stage Dumping Syndrome?

When your body senses food in the small intestine (especially sugar), it responds by producing insulin. Unfortunately, your body’s response is an overreaction in this case, and the sudden and excessive dump of insulin is too much for the amount of sugar, which leads to a drop in your blood sugar. This causes symptoms like fainting, fatigue, and feelings of confusion and weakness. It also causes hunger, because your body now craves sugar to make up for the large amount of insulin in your system.

This also means that patients who had diabetes before surgery may be at greater risk of experiencing these symptoms after surgery. However, it’s worth noting that surgeries like the gastric bypass or duodenal switch are extremely effective at curing type II diabetes.

How Can I Treat My Dumping Syndrome?

Treating dumping syndrome is typically simple. It’s just a matter of identifying what foods cause your symptoms, and avoiding those foods. In many cases, these are the foods that we’ll tell you to avoid anyway (like candy, cake, and soda). Also healthier foods that are high in fiber may decrease dumping, so in a strange way dumping syndrome actually reinforces good eating habits!

If you’ve tried fixing your diet and still have symptoms, you may need a medical treatment. This is very rare.

Treating Your Dumping Syndrome By Changing Your Diet

In most cases, if you avoid the foods that cause these symptoms, you’ll no longer suffer from rapid gastric emptying. Generally, rapid gastric emptying is caused by eating fatty or sugary foods, so avoiding these tends to eliminate dumping syndrome symptoms. In the case of eating fruit (which you should generally not remove from your diet), you can balance out the sugar by eating protein or fiber in the same meal, which helps reduce the threat of dumping.

Foods to avoid on an anti-dumping syndrome diet:

If you’re not sure what foods are causing your “dumping”, keeping a food journal may help. You can also talk to our expert dietician, who will be able to make some recommendations for your dumping syndrome diet. Some patients see their food intolerances evolve in the years after surgery, and may become intolerant of food they were able to eat right after surgery. On the other hand, some patients find that they become more tolerant of some foods over time.

Rapid gastric emptying may also occasionally be caused by eating food that’s too hot or too cold, or by eating solids and liquids together; so avoiding these behaviors can resolve symptoms. Finally, it can be caused by eating too quickly, so make sure to slow down, chew each bite thoroughly, and eat 5-6 small meals per day rather than 3 large ones.

All of these behaviors are what you should be doing anyway in order to maximize lasting weight loss after bariatric surgery. Because of this, many patients view rapid gastric emptying as a strange benefit, because it helps to keep them on the right track. By adopting a strict anti-dumping syndrome diet, you’ll also be setting yourself up for long-term weight loss.

Medical Treatments

Very rarely, optimizing your diet may not fully resolve your symptoms of dumping syndrome. In rare cases, medicine may be required: acarbose, which slows the absorption of carbohydrates into your system, can help. In very rare cases of extremely resistant symptoms, surgery may be needed to provide relief by reconstructing the pylorus (the opening from the stomach into the small intestine) to better regulate food passage into the intestine. Very few patients need this as almost all respond well to more conservative measures.

At the BMCC, if you’re experiencing dumping syndrome, our expert dietician will work with you to figure out what’s causing it and recommend a diet that won’t result in symptoms.

If you’re experiencing dumping syndrome symptoms, please get in touch today. We can help.

How Common is Dumping Syndrome?

Dumping syndrome is one of the more common side effects of gastric bypass surgery, but it’s still fairly rare overall because other bariatric procedures do not generally produce dumping and most bypass patients do a very good job of following their recommended diet to avoid symptoms. While up to 70% of bypass patients could potentially experience dumping, a recent study found that only about 20% of patients actually suffered from it. And while dumping syndrome symptoms can be uncomfortable, they are easy to manage by simply sticking to a strict diet.

How Should Dumping Syndrome Affect My Decision?

Bariatric surgery has life-changing benefits. Our patients report that they lose 100-200 pounds or even more, and can go on hikes and run races. Many say they feel like they have their life back, and they’re no longer trapped in their body.

Bariatric surgery also has enormous health benefits. Many patients report that losing weight helps them lower their blood pressure and cholesterol. Surgeries like the gastric bypass and duodenal switch have a strong track record of curing type II diabetes.

Dumping syndrome can be easily managed, and shouldn’t stop you from making a decision to change your life. If you do have questions, though, feel free to call or email our office.

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This page was medically reviewed by Dr. Joshua Long, MD, MBA, FACS, FASMBS. Dr. Long is a double-board-certified bariatric surgeon and bariatric medical director for Parker Adventist Hospital.
Full Bio: Dr. Joshua Long, MD, MBA, FACS, FASMBS
Page Updated: February 24th, 2020

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