Dumping Syndrome After Bariatric Surgery

You just had few bites of ice cream because you were at a birthday party and saying no was just not an option this time. About 45 minutes after eating the ice cream, you start to feel dizzy, a bit disorientated, and panic starts to take over your mind and body. Then you begin to sweat profusely and your hair and shirt become completely soaked. Your skin is glistening and sweat is dripping on the floor. During this state of sweaty panic, you feel like you've lost your mind. The state of distress is so severe that you're not sure what to do next: lie down, start pacing, sip some water, or eat something really 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've 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?

Early dumping typically occurs 30-60 minutes after eating and can last up to 60 minutes. Symptoms include sweating, flushing, lightheadedness, tachycardia, palpitations, desire to lie down, upper abdominal fullness, nausea, diarrhea, cramping, and active audible bowels sounds.

Early dumping occurs as a result of rapid emptying of sugars or carbohydrates from the gastric pouch into the small intestine.  In response, the body releases large amounts of insulin to absorb the sugars, leading to low levels of sugar in the body (hypoglycemia).  This release can affect your blood pressure, heart rate, skin flushing and intestinal transit, leading to a light-headed, rapid heart rate and flushing sensation often accompanied by diarrhea. Early dumping syndrome usually occurs for three to four months after surgery.

Late dumping which usually occurs 1-3 hours after eating. Symptoms are related to reactive hypoglycemia (low blood sugar) which include sweating, shakiness, loss of concentration, hunger, and fainting or passing out.

Late dumping symptoms are related to increased insulin after oral glucose (sugar) with subsequent hypoglycemia (low blood sugar).  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.  Late dumping syndrome can occur for an entire year post-op, and it may persist for many years. If you experience any of these symptoms, contact your health provider to review your food diary and implement changes to combat this issue.

Who Experiences Dumping Syndrome?

The most common type of bariatric surgery associated with dumping syndrome is gastric bypass (or Roux-en-Y Gastric Bypass) and DS (Duodenal Switch), however some sleeve (Vertical Sleeve Gastrectomy) patients report symptoms that appear to be dumping syndrome as well. Dumping syndrome is not commonly, if at all, reported in band (Adjustable Gastric Band) patients.  Not all gastric bypass or sleeve patients will experience dumping syndrome though. Talk with your surgeon if you’re considering bariatric surgery about which surgery is right for you and your chances of developing dumping syndrome with each procedure.

Treatments

If you have signs and symptoms of dumping syndrome, you’re 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’s 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 3 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 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. 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 complex carbohydrates, such as grains, starchy vegetables and fruits. These are high in fiber and help to slow down gastric emptying. 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 bariatric 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 bariatric 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’s important to manage those dumping syndrome symptoms so you stay well-nourished and don’t 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.

Updated 8.30.2022

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 remember that this article is not intended to provide individual medical advice. Every bariatric patient is different and it’s important to seek medical advice from your surgeon, dietitian, and nurses at your bariatric hospital or clinic.