Whether you are planning your bariatric surgery or already had one, it’s crucial that you know the most important facts about dumping syndrome after gastric bypass and gastric sleeve. It is one of the most common conditions after weight loss surgery. Luckily, most bariatric patients experience only mild symptoms, and they usually last from a few weeks to a few months.
Let’s have a closer look at the dumping syndrome definition, symptoms, levels, and causes. We’ll also give you some hints on how to prevent and treat dumping syndrome after gastric sleeve and gastric bypass surgery.
What is dumping syndrome?
Dumping syndrome can be defined as a common health condition in which food moves rapidly from the stomach to your small intestine. Another term used for this syndrome is rapid gastric emptying. (1)
There are two types of dumping syndrome you may experience: early or late. Early dumping syndrome is a condition that occurs from 30 to 60 minutes after eating, while late dumping syndrome happens after 1 to 3 hours following your meal.
An early syndrome is the most common type, while a late one happens to only 25% of weight loss surgery patients. However, it’s sometimes difficult to understand the difference between these two. Moreover, they can also occur at the same time. (2) It’s always best to consult your doctor about the symptoms you experience after your gastric surgery.
What are the levels of dumping syndrome?
The symptoms after gastric bypass and sleeve gastrectomy may differ, depending on the level. Symptoms of both early and late dumping syndrome can become mild or severe. Specialists have created many different kinds of questionnaires and scales to measure dumping syndrome symptoms. Some of them include only early dumping and therefore can be filled out by the patients. Other are scales that include lists of both early and late dumping, and these complications need to be measured by your doctor.
What are the symptoms of dumping syndrome?
In order to differentiate the two levels of this syndrome, here is a list of all the potential symptoms.
Early dumping syndrome symptoms can be listed as:
- diarrhea and nausea,
- feeling uncomfortably full,
- pain and cramping,
- tiredness
- headache,
- fast or irregular heartbeat,
- extensive sweating.
Late dumping syndrome symptoms occur due to low blood glucose and include:
- feeling light-headed or fainting,
- feeling shaky
- feeling extremely tired, and weakness
- heart palpitations,
- sweating,
- trouble concentrating (1)
How long does dumping syndrome last?
It varies. Early dumping syndrome usually takes a maximum of 3 to 4 months after the procedure. Late dumping syndrome may on the other hand continue even for a year.
The length of dumping syndrome is related to the type of dumping level you’re experiencing, as well as your diet choices and lifestyle changes. As long as you are implementing your doctor’s instructions and following your dietary recommendations, you decrease your chances of the symptoms.
Does it improve over time?
Yes, it does. Most patients experience mild symptoms that improve over time, so in most cases, dumping syndrome is not a permanent condition. Only in very rare cases, only if not treated properly, it may persist for years.
Is dumping syndrome a serious condition?
Yes, dumping syndrome may become a serious condition. In some cases, it may be the reason for a very quick loss of weight and cause some nutritional deficiencies. If a symptom such as diarrhea continues for a long time, it may lead to dehydration. Remember that this kind of problem might usually be controlled and prevented.
Can this syndrome be a sign of a more serious condition?
Yes, it can. When it comes to late dumping syndrome, a lot of sugar enters your small bowel and for this reason, your body absorbs it too quickly. This is the reason the pancreas releases too much insulin which results in a very low level of sugar in your blood. This condition is called hypoglycemia. (3)
How common is it and who is more likely to have it?
What are the chances of dumping syndrome after gastric sleeve and gastric bypass surgery? Studies show that approximately 20-50% of patients who had stomach surgery develop some of the symptoms, from 5 to 10% of them in a severely disabling form. These numbers differ depending on the type of procedure.
It’s much more likely that you will experience the symptoms after your gastric bypass surgery. About 85% of gastric bypass patients will experience some dumping syndrome symptoms at some point after their surgery, and around 40% among sleeve gastrectomy patients. (2)
What causes dumping syndrome?
Reasons for this syndrome are mostly related to surgical operations performed on your stomach. However, there are also disease-related causes of this condition.
Food high in sugar is likely to cause dumping syndrome. This is because the high amount of sugar gets more water into the small intestine and this way can move gastric contents faster. Apart from meals high in sugar, also high-fat foods may be the reason.
You should definitely avoid rapid eating. It will lead to sudden fill and sudden emptying. Take small bites and chew your meals slowly.
Keep in mind that drinking while eating your food can also trigger dumping syndrome symptoms. Instead of water intake during your meals, drink your liquids continuously throughout the day.
What types of gastric surgeries can cause?
Weight loss surgeries that can cause dumping syndrome include gastric bypass and sleeve gastrectomy. Other stomach surgeries that may be the reason for this syndrome are pyloroplasty, esophageal surgery, vagotomy, and Nissen fundoplication.
Can it occur without gastric surgery?
Yes, it can. Disease-related causes are:
- Diabetes
- Exocrine pancreatic insufficiency
- Duodenal ulcers
- Zollinger-Ellison syndrome
- Functional dyspepsia
- Cannabis hyperemesis syndrome
Can stress trigger dumping syndrome?
You should know that stress doesn’t trigger dumping syndrome. Anxiety however is one of the late symptoms.
You need to remember though that stress can affect your stomach in a negative way. It’s easy to be confused if your symptoms are because of stress or dumping. Common symptoms related to stress are heartburn, indigestion, nausea or even vomiting, in extreme cases. Diarrhea, constipation, and pain in your stomach may also be the symptoms of long-term stress.
How it's diagnosed
If you had a gastric bypass surgery or a sleeve gastrectomy, your doctor can diagnose dumping syndrome based on your symptoms. It’s possible that they can also decide you should take some tests to confirm the diagnosis. There are 5 key methods of diagnosing it, and two of the most popular are the oral glucose tolerance test and the gastric emptying test.
The most common way to diagnose dumping syndrome is an oral glucose tolerance test, which measures your blood sugar before and after drinking a glucose solution. This test can also measure your red blood cell count. If there is an increase after you drink the glucose, it means that the excess fluid volume moves from your blood to your intestines. When your blood sugar drops from 1 to 3 hours after the test, you suffer from a late dumping syndrome.
Another way of detecting is a gastric emptying test, which measures how rapidly the food moves through your stomach. A very small amount of radioactive material will be added to your food and a doctor will then observe how your meal moves through the stomach. This way they will be able to measure your gastric emptying rate.
How it's treated
You can cure dumping syndrome by changes in your diet and exercises. If changing your eating habits and staying active don’t improve the symptoms, your doctor may prescribe medications. In some rare cases, when dumping syndrome is a result of gastric surgery, and when all other solutions fail, your physician may recommend another surgery to treat it.
What you can do is...
You can implement some dietary changes into your eating habits, as well as stay active after your surgery. Try drinking around 2 liters of water a day. Keep in mind it’s better to drink liquids between, not during the meals. You should also lie down for 15 minutes after you eat.
Try to stay away from any kind of sugar, refined or natural, until your symptoms are gone. You can start consuming natural sugar step by step such as fruits.
You can also try to eat your meals slower. To focus only on your meal, do not eat your meal while doing other activities such as watching TV.
How does exercising help?
Physical activity helps to promote a healthy digestive system while you are in a recovery process after your weight loss procedure. Regular exercises may also help you in reducing the symptoms of dumping syndrome.
Change your diet plan
Your diet should include both protein and fat: poultry, red meat, fish, eggs, tofu, nuts, and cheese. Slowly add more fiber to your meal plan. Some patients add pectin, which is known to delay gastric emptying. It can also decrease dumping symptoms when mixed with meals that contain glucose. (4) You may also try guar gum, which has similar effects. (5) It’s best to have 5-6 smaller portions a day, instead of having 3 large meals.
Remember to check with your doctor if you can include these foods in your diet. For example, soft cheeses like mozzarella or ricotta are usually tolerated. However, you should avoid harder cheeses like cheddar, because they may be more difficult to digest.
Medications
If the syndrome continues despite changes in your diet and sports activities, a doctor can prescribe some medications to help you solve this problem. Acarbose is a kind of medication that can be used in treating diabetic patients. Its main aim is to lower your blood sugar level after it increases following your meal. This way it helps to control reactive hypoglycemia. (6) Another solution is an octreotide injection (Sandostatin drug). It’s an injected anti-diarrheal medicine. Sandostatin may slow down the emptying process of your stomach.
I did everything but I still have it
For most patients, the symptoms improve over time. If they don’t, you should definitely consult your doctor. You need to inform your physician about any long-term symptoms of dumping syndrome, because they may lead to some serious nutritious deficiencies and dehydration.
Does it need to be monitored?
Yes, it does. Dumping syndrome may last for years and get dangerous for your health. Especially late dumping syndrome may persist for a very long time. Specialists advise patients who experience severe symptoms to contact the doctor and check if there is anything to worry about. (7)
When dumping syndrome is diagnosed, you should consult a dietitian. They will explain to you all the necessary dietary changes and adjust them to your needs. It is important that you monitor your weight to make sure you consume the required calories and nutrition. If symptoms do not improve after dietary modifications, see your doctor again. You may need some prescribed medications as an addition to your diet.
What are the long-term effects?
Some patients with long-term dumping syndrome might start to avoid eating to prevent the symptoms. This can lead to unhealthy weight loss and malnutrition. It can cause dizziness, tiredness, and lack of focus.
Can dumping syndrome cause weight gain or weight loss?
The result of a dumping syndrome can be both weight loss and weight gain.
For some sleeve gastrectomy patients dumping syndrome symptoms can be extremely stressful, so they limit the amount and type of food extremely, therefore losing extreme weight. (8) On the other hand, if you avoid healthy foods that are rich in nutrition, you may tend to replace them with liquids high in simple sugars that will give you an energy boost. This way you will experience both excess calorie intake and you may cause insulin-related problems that may also result in gain weight in the future.
Knowing this, it’s important that you talk to your doctor when your first symptoms occur.
How to prevent
If you want to try to prevent dumping syndrome from happening, there are some foods you can avoid in your diet. One of the side effects of dumping syndrome is that you eat properly which allows you to quickly learn what you should and shouldn’t include in your diet after the bariatric surgery.
What foods should be avoided to prevent this syndrome?
Avoid simple carbohydrates. Any sort of sweets, sugary drinks, fried food, and high-processed meals need to be excluded from your new healthy diet. You shouldn’t eat fruit that has a digestive effect, such as peaches or apricots. You also need to avoid any milk products other than cheese. It’s recommended to exclude food in extreme temperatures, so the meals that are too hot or very cold. Extreme temperatures can increase gastric motility and emptiness. Remember not to drink while you eat, but half an hour before and after your meals and between them.
References:
(1) van Beek AP, Emous M, Laville M, Tack J. Dumping syndrome after esophageal, gastric or bariatric surgery: pathophysiology, diagnosis, and management. Obes Rev. 2017 Jan;18(1):68-85. doi: 10.1111/obr.12467. Epub 2016 Oct 17. PMID: 27749997. Link
(2) Vavricka SR, Greuter T. Gastroparesis and Dumping Syndrome: Current Concepts and Management. J Clin Med. 2019 Jul 29;8(8):1127. doi: 10.3390/jcm8081127. PMID: 31362413; PMCID: PMC6723467. Link
(3) Mejia-Otero JD, Grishman EK, Patni N. Diazoxide for the Treatment of Hypoglycemia Resulting From Dumping Syndrome in a Child. J Endocr Soc. 2019 Jun 5;3(7):1357-1360. doi: 10.1210/js.2019-00120. PMID: 31286099; PMCID: PMC6608547. Link
(4) Andersen JR, Holtug K, Uhrenholt A. Trial of pectin-enriched muffins in patients with severe dumping syndrome after gastric resection. Observations on symptoms and gastric emptying pattern. Acta Chir Scand. 1989;155(1):39-41. PMID: 2929202. Link
(5) Harju E, Larmi TK. Efficacy of guar gum in preventing the dumping syndrome. JPEN J Parenter Enteral Nutr. 1983 Sep-Oct;7(5):470-2. doi: 10.1177/0148607183007005470. PMID: 6315982. Link
(6) Cadegiani FA, Silva OS. Acarbose promotes remission of both early and late dumping syndromes in post-bariatric patients. Diabetes Metab Syndr Obes. 2016 Dec 7;9:443-446. doi: 10.2147/DMSO.S123244. PMID: 27994477; PMCID: PMC5153290. Link
(7) Arts J, Caenepeel P, Bisschops R et al. Efficacy of the long-acting repeatable formulation of the somatostatin analogue octreotide in postoperative dumping. Clin Gastroenterol Hepatol 2009; 7: 432–437. Link
(8) Ukleja A. Dumping syndrome: pathophysiology and treatment. Nutr Clin Pract. 2005 Oct;20(5):517-25. doi: 10.1177/0115426505020005517. PMID: 16207692. Link
