I’m sweating, nauseous, cramping, shaking, and feel like I’m going to throw up. My heart starts to beat faster and I feel like I need to lie down or I will fall down. What is happening to me? I think back to what I ate in the last hour. Crap! I had a protein bar, I’ll bet that had hidden sugars in it. I’m dumping.
If you are considering getting bariatric surgery, one of the topics you’ll want to read about is “dumping syndrome,” also called “rapid gastric emptying”. But what exactly is dumping? In this post we will look at:
- What dumping is and what happens
- What causes dumping and who is at the most risk
- How to reduce the risk
What dumping is and what happens
Dumping syndrome occurs when sweet and/or fatty foods have been consumed too quickly or in too large a quantity. The stomach dumps the food into the small intestine before it’s properly broken down. Dumping syndrome usually causes nauseousness, cramping, diarrhea, sweating, vomiting, or an increase in heart rate; these symptoms usually wear off after one or two hours. But the experience of ‘dumping’ is very unpleasant and you will want to avoid it.
There are 2 types of dumping syndrome: early and late.
Early
Early dumping happens 10 to 30 minutes after a meal and can be brought on by eating foods high in fat, carbohydrates, or sugar or by eating foods that are too cold or too hot or by drinking liquids during your meal.
Early symptoms include:
- Bloating
- Diarrhea
- Abdominal cramps
- Dizziness
- Heart palpitations
- Nausea
- Rapid heart rate
- Sweating
- Vomiting
- An urge to lie down after the meal
Late
Late dumping happens 1 to 3 hours after eating and is a form of hypoglycemia (low blood sugar). When you ingest too much sugar, your now smaller stomach does not digest it properly so your intestines absorb and deposit too much of it into your bloodstream. Your body compensates by releasing more insulin and that makes your blood sugar drop. Only about 1 in 4 people will get late dumping with an episode. If you are lucky, you will just have early dumping symptoms.
Late symptoms include:
- Anxiety
- Diarrhea
- Dizziness
- Fainting
- Fatigue
- Confusion
- Problems concentrating
- Rapid heart rate
- Hunger – your body craves more sugar to balance the increase of insulin in your system
- Weakness
- Heart palpitations
- Sweating
- Tremors
Some patients’ tolerance for the items which have caused dumping syndrome in the past can change with time. For example, some patients who cannot tolerate sugar immediately after surgery may be able to handle it in small amounts several years out. I can tolerate more sugar later in the day after I have absorbed some natural sugars in food.
What causes dumping and who is at the most risk
Early dumping syndrome occurs because of the dense mass of food that gets dumped into your small intestine. Because it is at an earlier stage of digestion, the intestines sense that this food mass is too concentrated, and releases gut hormones. Your body reacts by shifting fluid circulating in your bloodstream to the inside of your intestine, causing bloating. Diarrhea and/or vomiting often occurs 30 to 60 minutes later. In addition, certain hormones are released by your intestine that affects heart rate and often blood pressure, causing rapid heart rate, dizziness, or even fainting.
Symptoms of late dumping happen because of reactive hypoglycemia which is a decrease in blood sugar level. This low blood sugar happens 1 to 3 hours after a large surge of insulin. You are more likely to have dumping syndrome if you eat a meal heavy in starches or sugars. The sugars can be either regular sugar, also called sucrose or fructose.
As many as 70% of gastric bypass patients experience dumping syndrome, but less than 5% of these people have serious symptoms. The more of your stomach that has been removed, the more likely you are to dump. Some surgical procedures are more likely to produce dumping because they separate or remove part of the stomach. The surgeries that have a higher risk of causing dumping are:
- Gastric bypass surgery – These are the combination of malabsorptive and restrictive (RNY and Biliopancreatic diversion with duodenal switch)
- Gastric sleeve surgery
- Mini gastric bypass surgery
There are a few bariatric surgery procedures that will probably not cause dumping. They are:
- Adjustable gastric banding (lap band surgery)
- Gastric Balloon
- Vertical banded gastroplasty (VBG)
If you have a condition that affects blood sugar levels, such as diabetes, your chances of experiencing dumping are increased.
How to reduce the risk
The only real treatment for dumping syndrome is a change in your diet. If you are like many people, this may sound next to impossible, but luckily you have some help. Many patients’ cravings for these foods completely change after surgery. And if the cravings don’t stop you, the fear of dumping can have a strong psychological impact that could cause you to lose the taste for these foods.
Here are a few things that you can do to reduce your risk of dumping:
- Avoid high sugar/refined carbohydrate foods.
- Eat very slowly.
- Chew your food well.
- Don’t drink liquids until at least 30 minutes after a meal.
- Divide your daily calories into 5 or 6 small meals.
- Lie down for 30 minutes after a meal to help control the symptoms.
- Add more protein and fat to your meals.
Giving up sugar can be tough to imagine. The good news is that you don’t necessarily need to be entirely deprived. There is a wide range of sugar substitutes and sugar-free products now available that can be included in your meal plan. Be sure to check with your surgeon to see what sugar substitutes they recommend for your particular surgery.
Eating five or six smaller meals a day instead of three bigger ones can make digestion easier on your system and won’t “shock it” with so much food at once. Don’t drink anything with your meals as this can increase the speed at which your food passes through your stomach and into your intestine. Lie down after eating. Gravity can pull food through your system more quickly when sitting down or standing, so lie down after eating to help your food pass through more slowly. Anyone who suffers from gastro-esophageal reflux disease (GERD) may worsen their symptoms by lying down after eating. If you suffer from GERD, your doctor may recommend that you wait 3 hours before lying down after a meal.
Sometimes it can be difficult to figure out what food is triggering your dumping. Keeping a food journal is a great way for you to track and remove foods that could be causing dumping. Many times, it is the natural sugars found in fruits or juices that cause dumping. Fruit can be okay as long as you have plenty of protein, fiber, and complex carbohydrates in your diet to balance the sugar out.
Certain foods are very difficult to digest especially early in your recovery and should be approached with caution. These include:
- Beef
- Pork
- Shellfish
- Grapes
- Nuts
- Whole grains
- Corn
- Beans
- Dairy foods
If dietary changes alone do not help with your dumping, your healthcare provider may give you some slow-release prescription medicines. In severe cases of dumping syndrome, your healthcare provider may suggest tube feeding or corrective surgery. Keep your doctors informed of your symptoms so they can determine what measures should be taken.
As awful as it is, dumping is often thought of as a good thing by weight loss surgery patients since it discourages poor diet choices. It is one of the best deterrents to keep my diet on track. You get an almost immediate reaction. Last week, my family bought me candy corn for my birthday, my favorite(don’t judge, they are soooo good). I knew I would be ok if I had 1 or 2. So what did I do? I ate 7 or 8. I was thinking, “It should be ok. I can probably handle more sugar than I think” as I popped a few in my mouth. I was wrong. I knew I had made a horrible mistake about 15 minutes later when I started shaking and sweating. Within an hour I was in the bathroom praying for death. I am 18 years out and still do stupid things. I have no one to blame but myself. You will make bad decisions too. None of us are perfect. Give yourself a little grace and hopefully, you will do better next time. As long as it is not candy corn, I should be ok.
