Dietary advice ‘Dumping Syndrome’ after Surgery

What is Dumping syndrome?

Dumping syndrome is the name given to a collection of symptoms which may be experienced following surgery to the stomach or gullet.

The symptoms fall into two groups; early dumping syndrome and late dumping syndrome, which may also be called post prandial hypoglycaemia.

Symptoms which occur within 30 – 60 minutes of eating, are referred to as early dumping syndrome and may include nausea, bloating, borborygmi (a word that means tummy rumblings) and diarrhoea.

Late dumping syndrome is quite different to early dumping syndrome and occurs 1 to 3 hours after eating. Symptoms may include feeling faint, sweaty, lethargic and a racing heart

What causes dumping syndrome?

Both early and late dumping syndrome are partly due to food emptying rapidly from the stomach into the bowel as a result of surgery.

Normally, the stomach acts as a reservoir for food. After food has been swallowed it enters the stomach and is mixed with digestive juices which start to breakdown the food so that it can be absorbed into the body from the intestine (gut). The intestine is a long pipe-like organ. The speed at which the food enters the intestine is controlled by a valve at the lower end of the stomach (the pylorus).

In surgery this valve may be removed or may not work well after the operation. Food then moves from the stomach into the intestine a lot quicker. This rapid movement of concentrated, partly digested food causes the intestine to draw in water from the body, resulting in a drop in blood pressure and feelings of faintness. It can also cause feelings of bloating, rumbling stomach noises, crampy abdominal pain and diarrhoea.

The full mechanism of dumping syndrome is not yet fully understood but is a complex process also involving changes to gut hormones.

Late dumping syndrome (post prandial hypoglycaemia) is thought to occur as a result of rapid absorption of sugary foods and drinks from the intestine. This results in a sudden rise in blood sugar levels. The body then releases insulin, a hormone which controls blood sugar levels.

If too much insulin is released, blood sugar levels can drop quickly and this can cause symptoms of weakness, feeling faint, feeling sweaty and dizziness or feeling tired and needing to lie down. This is also called reactive hypoglycaemia.

It is important to remember that although the symptoms of early dumping syndrome can be unpleasant they rarely cause harm. Post prandial hypoglycaemia (late dumping syndrome) is unpleasant and may be very severe for some people resulting in fainting or loss of consciousness

What is the treatment for dumping syndrome /post prandial hypoglycaemia?

Symptoms from early dumping usually resolve without any treatment as the gut adapts to the post-surgery changes but this can take several months. Sometimes, symptoms can improve or be prevented by a combination of dietary changes and medications. Post-prandial hypoglycaemia (late dumping syndrome) may present several months or years after surgery.

Dietary advice for dumping syndrome

Following surgery, advice is given to change diet and eating pattern in the following ways:

• Eat small, frequent meals and snacks. Initially after surgery portion sizes need to be halved. This helps reduce dumping syndrome as it prevents over eating. Avoiding long gaps between eating can also help to keep blood sugar levels stable.
• Separate food and drinks and leave a 30 minute gap between drinking and eating a meal. This helps to prevent feelings of fullness before meals and reduces the volume moving through the digestive system which can help prevent dumping syndrome.

• Include slower release starchy foods also known as low glycaemic index foods at each meal such as oats, beans, sweet potato, whole grains and basmati rice.
  Have a snack including starchy carbohydrates in between meals such as 2 plain biscuits, portion of fruit, low sugar yoghurt or glass of milk
• Limit foods and drinks high in sugar, particularly refined sugars such as caster sugar, syrup, honey, sweets and non-diet fizzy drinks. Avoid adding sugar to drinks and try using sweetener as an alternative, if necessary.
• Choose foods high in soluble fibre which will help slow down the passage of food through the digestive system, for example; granary and wholegrain varieties of breads and cereals, oats, lentils, pulses etc.
• Try to include a protein food with each meal and add protein to snacks. Protein is a key nutrient to aid recovery from surgery. Examples of protein foods include meat, fish, cheese, eggs, tofu, Quorn, lentils, pulses, milk and yoghurt.

Medications

There is no single medication to prevent or treat dumping syndrome. A doctor may recommend a medication to help with your symptoms. Anti-diarrhoeal medication can help reduce diarrhoea associated with dumping syndrome as it works by slowing down the time it takes food to pass through the gut.

If your symptoms persist or you suffer from pale, oily, loose, frequent stools that are difficult to flush, it is important to contact the Dietitian for further advice.

If you continue to have dizzy spells, please speak to your Dietitian, as further investigations may be needed.

If you have any further questions in relation to your diet and ‘Dumping Syndrome’ after Surgery, please speak to your Dietitian who will be able to advise further