What is Dumping syndrome?

Dumping syndrome is actually a group of symptoms sometimes faced by those who have undergone a gastrectomy or gastrojejunostomy (Roux-En-Y procedure). What happens, at its most basic level, is that the contents that would normally pass undigested into the small bowel, which can cause a number of complications and issues. 

Those who suffer from this problem generally find that it happens very soon after eating. However, with others, it could take one, or even up to three hours before the symptoms occur. Some people actually have problems right after eating, and later in the digestive process. 

Dumping Syndrome
Dumping Syndrome

What Are The Symptoms Of Gastric Dumping Syndrome?

There are a number of different symptoms, and they can vary based on how soon after eating one begins to feel them. 

Early Symptoms

Those who have early dumping syndrome issues immediately after eating (commonly between 30-60 minutes of eating) and is caused by rapid emptying of food into the small bowel. As a result, the high sugar levels (hypertonicity) in the small bowel allow passage of water into the bowel (by a process called osmosis) causing diarrhea. It also causes a fluid shift from your circulating blood volume, causing low blood pressure. These are the 2 main mechanisms causing the following symptoms: 

  • Nausea
  • Vomiting
  • Diarrhea
  • Uncomfortable feeling of fullness 
  • Abdominal cramps 
  • Tiredness and  Dizziness 
  • Sweating
  • Diarrhea
  • Early Satiety
  • Increased heart rate
  • Flushed skin 

Late Symptoms

For those who tend to develop late dumping syndrome symptoms (commonly 1 to 3 hours after food), it is caused by a rapid increase then a decrease in the blood sugar levels. The increase is caused by the high sugar load in the bowel resulting in initial hyperglycaemia (high blood sugar). In response to this, the pancreas secretes more insulin (hyperinsulinaemia) to deal with this high blood sugar level As a result, there is a rapid drop in the sugar levels causing low blood sugar (hypoglycaemia - sometimes refered to as alimentary hypoglycaemia) and causes the following symptoms:

  • Fatigue
  • Sweating
  • Hunger
  • Increased heart rate and anxiety
  • Tiredness
  • Fainting
  • Dizziness 
  • Confusion 

One of the things that can cause dumping syndrome to be even worse is to have a meal high in sugar. This includes sucrose, or normal table sugar, and fructose, fruit sugar. If you notice that eating certain types of food causes this to happen with you, cut those out of your diet and replace them with better options. 

Conditions Which Can Mimic This Disorder

  • Addisons DIsease - A condition where the body lacks steroid, resulting in a drop in blood sugar levels, low blood pressure and diarrhea
  • Zollinger-Ellison Syndrome - High gastrin levels from a gastrinoma - a gastrin secreting tumor which can occur in the UGI tract and pancreas
  • Ehlers-Danlos Syndrome- a genetic condition that can cause symptoms of dumping syndrome and can result in rapid stomach emptying and reactive hypoglycaemia
  • Esophagectomy - removal of the esophagus, usually as a result of esophageal cancer
  • Cholecystectomy - gallbladder removal surgery due to gallstones, cholecystitis or gallbladder cancer

Diagnosis

The diagnosis of dumping syndrome is usually made on the history alone. If your doctor is aware of your gastrectomy or gastrojejunostomy, the diagnosis is usually pretty obvious. They may want to confirm this by measuring your blood sugar levels after a sugar drink (referred to as a modified glucose tolerance test). They will also measure your pulse (causes a tachycardia or increased pulse), increased viscosity of your blood (an elevated hematocrit level) as well as the symptoms you have.

Severe Complications Can Occur 

If you start to notice these symptoms of dumping syndrome and if changing your diet doesn’t do anything to control them, then immediately see your doctor. It could cause you to lose even more weight if you let it go unchecked, and this is highly dangerous to your health. 

Sometimes, having low blood sugar can actually be a part of the condition, and your doctor may want to measure your blood sugar level during the time of your symptoms. This can aid in the diagnosis, and it may help them determine what you may need to add to your diet to help solve the problem. 

Puzzlingly, having too little sugar in the body (hypoglycaemia) can cause the problem, as can having too much sugar. 

Because of the symptoms surrounding dumping syndrome, some people actually end up developing a fear of eating. They do not want to have to deal with the discomfort that comes with the syndrome, so they stop eating. This leads to even more weight loss. 

Some people even find that the syndrome leads to a diminished social life and perhaps even anxiety and/or depression. They fear being away from home and away from the toilet. This can also make it difficult for some to keep their jobs when they are dealing with this problem chronically. 

Treating The Problem

Book About Dumping Syndrome Diet
Book About Dumping Syndrome Diet

Most of the time, making changes to your diet in dumping syndrome and simply seeing how eating different foods and in different amounts can help you will improve the digestive process. Many people find that with the right diet and the right eating habits, they are able to eliminate dumping syndrome. Others are not quite so lucky though, and they may need to seek medical help. 

Your doctor might prescribe medications that help to slow the digestive process in some cases. Some of the most common medications used are acarbose as a tablet and octreotide as a subcutaneous injection. Doctors only use these in the most severe circumstances, as slowing the digestive process too much means you will not absorb as many calories and nutrients as you need through the day, since you will not be able to eat as much. Some of the medications in use also have their own side effects, so your doctor is not going to want to prescribe them unless it is the only option. 

Prevention - My Tips

Specialists, like myself, normally recommend that you change your diet and eat smaller meals, which you should already be doing. Most also advise avoiding fluids with your meals, as well as waiting for about half an hour after eating before having anything to drink. 

Always chew your food completely and thoroughly before you swallow, as this helps to make digestion much easier. Also, make sure you have enough fiber (such as whole wheat pasta and bread, bran and other cereals - soluble fiber such as linseed and oats are good), and protein in your diet as these are all good foods that prevent dumping syndrome. Avoid drinking any alcohol, and be sure to stay away from acidic and spicy foods. Citrus fruits, tomatoes, and other foods that have high amounts of acid in them can be difficult for some to digest properly and can cause issues with you digestion. 

When preparing your food, it’s best to grill, bake, or broil. Avoid frying and similar methods of cooking, as it increases unhealthy fat and oils, which can cause issues with your digestive process. You want the calories, but you don’t want to do anything that will cause symptoms.

Finally, relax after eating and even lean back a bit. Slow things down a bit, so you can slow the movement of your food and so your body can rest during the digestive process. Eat six to eight small meals daily to avoid eating too much at a time.  You may be able to tolerate larger portions over time, but keep servings small at first. All these measures will help prevent dumping syndrome.

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