Sounds Bad, Feels Worse
I don’t know if it’s the aftermath of Easter (so much sweet food on offer) or a change in food choice at this time of year but I get a truckload of queries in April/May asking about stomach upsets, dizziness, palpitations and more. Can this be what we were warned about Carol – is this my first experience of dumping syndrome?
Well the short and long answer to many of these is maybe and probably. I say this after looking at the food that has usually triggered the effect and the symptoms experienced afterwards. Many WLS patients don’t experience dumping syndrome, some do easily and many only do when they ‘chance their hand’. In literature it is generally associated with the gastric bypass operation but I do know of sleeve patients who record this too. But what is dumping syndrome?
This lovely sounding syndrome results from the rapid passage (or “dumping”) of undigested food into the small intestine, causing a rapid shift of fluid as the body tries to “dilute” the contents of the intestine. This shift in fluid causes cramping and diarrhoea and can also result in a drop in blood pressure, causing weakness and sweating.
Why Does A Gastric Bypass Make This Possible?
Well, as a result of the surgery, you no longer have the valve that regulates how fast food empties out of the stomach. The surgery also causes food to enter the gastrointestinal tract at a point lower down than it’s supposed to due to the first part of the small intestine having been “bypassed.”
That first part of the small intestine is where sugars normally are metabolised. So basically you’re now dumping sugar lower in the intestines, where they aren’t equipped to handle it. The result: your body rebels! So dumping happens when food (especially sugar) moves too quickly though the stomach and is ‘dumped’ into the small intestine. The body has a tough time handling this rapid ‘dumping’ and responds by adding a large amount of fluid to the small intestine. The fluid is the cause of patient dumping symptoms. Thankfully, this does not usually require medical treatment.
…eat the wrong thing and you can feel really really sick for many hours.
Here’s one patient’s account of what dumping syndrome feels like:
Shortly after eating a food I don’t tolerate (sugar, milk, sugary milk products or starchy carbs) I begin to feel a bit disoriented, maybe dizzy and then an overall sense of confusion or panic takes over my mind and body. This is a mild state of delirium. Then I begin sweating. Profuse sweating that can completely soak my hair, my clothes; it drips and glistens on my skin. During this state of sweaty panic I feel like I’m out of my mind! A few times during extremely dramatic dumping episodes I literally thought I was dying, the state of distress was that severe.
Dumping syndrome can cause diarrhoea, nausea, vomiting, increased heart rate, sweating and cramping. Symptoms can occur immediately (“early dumping”) or 1-3 hours after eating (“late dumping”).
Causes of Dumping Syndrome
- Eating sweets or foods high in sugar
- Eating too much at one meal
- Having solids and fluids together
- Eating foods that are fried, fatty, or greasy
How To Avoid Dumping Syndrome
- Avoid/limit concentrated sugars like biscuits/cookies, cake, pies, sugar, and syrup
- Read food labels for sugar content. Avoid foods with sugar listed among the first three ingredients
- Eat six small meals daily instead of three large meals if you are very susceptible
- Eat slowly
- Avoid eating and drinking at the same time. Wait 30 minutes before and after a meal to drink fluids. Drink low sugar beverages only
A Note About Sugar
“Sugar Free” foods and drinks often contain sugar alcohols which may not be well tolerated either. So note:
Words ending in -ose are generally forms of sugar.
The following is a list of sugars and sugar alcohols to try to avoid in large quantities:
- barley malt
- brown sugar
- cane sugar
- confectioner’s sugar
- corn syrup
- corn sweeteners
- granulated sugar
- high fructose corn syrup
- invert sugar
- maple syrup
- raw sugar
- table sugar
While dumping syndrome is certainly no fun to experience, the negative feedback is often a convincing motivator to stick to your post weight-loss surgery diet guidelines! If you’d always wished your dentist could have just pulled out that “sweet tooth,” this could be the next best thing.
I’ve had patient after patient tell me how their addiction to sugar was instantly broken after experiencing dumping syndrome. In truth it sounds bad and feels worse!
Types of Dumping Syndrome
There are two kinds of dumping, early and late. Both occur after a meal, especially after eating foods high in fat, carbohydrates or sugar (both table and natural, like that found in fruit).
Early dumping occurs within 30 minutes of eating a meal. In addition to high fat, high carbohydrate and high sugar foods, it can also be brought on by eating foods that are too hot or too cold, or drinking liquids during your meal. Such early symptoms include bloating, vomiting, diarrhoea, heart palpitations, nausea, sweating, dizziness and a rapid heart rate.
Late dumping is a form of hypoglycaemia (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 then compensates by releasing more insulin which makes your blood sugar drop. Symptoms for this late dumping include anxiety, heart palpitations, fainting, fatigue, diarrhoea, rapid heart rate, a strong feeling of hunger, sweating, weakness, dizziness and confusion.
As long as you do not stray from your prescribed bariatric diet, you should not experience ‘dumping syndrome’. For this reason, many patients view it as a ‘blessing in disguise’ since it helps to keep their diet on track.
Interestingly, some patients’ tolerance for foods that might trigger ‘dumping syndrome’ can change over time. Some find that several years out of surgery they can tolerate small amounts of foods they could not eat in the earlier days.
As many as 80% of gastric bypass patients experience ‘dumping syndrome’ but less than 5% have serious problems with it. As a general rule, the more of your stomach that has been removed, the more likely you are to dump.
The treatment is to wait and let the symptoms pass – many patients find bed rest helpful.