How to treat and prevent dumping syndrome, a common and sometimes serious side effect of bariatric surgery
- Up to 50% of people may develop a side effect called dumping syndrome after bariatric surgery.
- After eating, you may have an upset stomach, weakness, confusion, heart palpitations, or fainting.
Bariatric surgery can help manage obesity and related health issues, like back pain, high blood pressure, and diabetes. But between 25%-50% of people who have undergone this procedure will experience a potentially serious side effect called dumping syndrome.
Dumping syndrome can happen when food that contains too much sugar or simple carbohydrates "dumps" — empties quickly, in other words — from your stomach into your small intestine, says Dr. Saber Ghiassi, board-certified surgeon and director of bariatric surgery at Bridgeport Hospital.
The syndrome has two types:
- Early dumping, which happens shortly after you eat. It can cause digestive discomfort, dizziness, and a rapid heart rate.
- Late dumping, which happens a few hours after you eat. It tends to cause more whole-body effects, like weakness, confusion, or irritability.
Early dumping happens more often than late dumping, but you can have both types.
Bariatric surgery leads to most cases of dumping syndrome but any surgery that changes the shape of your stomach can cause dumping syndrome, as can certain medical conditions.
Read on to learn how to recognize the symptoms of dumping syndrome and the dietary changes you can make to manage your symptoms.
Symptoms
In early dumping, your body reacts to the "dumped" food by releasing hormones that cause fluids to rush into your small intestine. These hormones raise your heart rate, lower your blood pressure, and cause digestive upset, Ghiassi says.
The symptoms of early dumping usually start within an hour after you eat a meal and may include:
- Abdominal pain and fullness
- Nausea and vomiting
- Diarrhea
- Borborygmus (a rumbling sound in your stomach)
- Bloating
- Fatigue
- Feeling faint or lightheaded
- Headache
Late dumping happens in up to 25% of people after bariatric surgery. It occurs due to fluctuations in your blood sugar, says Dr. Mitchell Roslin, chief of bariatric surgery at Lenox Hill Hospital.
First, the mass of food dumped into your small intestine raises your blood sugar. Your body then responds by producing large amounts of insulin. The excessive amount of insulin lowers your blood sugar too much, causing hypoglycemia, which leads to the symptoms of late dumping.
You'll typically notice these symptoms one to three hours after eating. They can include:
- Fatigue
- Weakness
- Fainting
- Confusion
- Perspiration
- Palpitations
- Tremors
- Irritability
Causes
Though most cases of dumping syndrome happen as a side effect of bariatric surgery, dumping syndrome also occurs in about 10% of people who undergo any type of gastric surgery, including:
- Gastrectomy: The removal of your stomach, usually to treat stomach cancer.
- Esophagectomy: The removal of your esophagus to treat cancer.
- Fundoplication: A procedure that changes the shape of your stomach to treat gastroesophageal reflux disease (GERD) and hiatal hernia.
- Vagotomy: A surgery that cuts the vagus nerve to help treat stomach ulcers.
- Pyloroplasty: A procedure used to treat gastroparesis and other stomach conditions by widening the opening at the bottom of your stomach.
Less commonly, some medical conditions might cause dumping syndrome, including:
Diagnosis
It's best to check in with your doctor as soon as possible if you notice symptoms of dumping syndrome, especially if they involve fainting or don't stop after you make dietary changes, Ghiassi says.
Your doctor may diagnose dumping syndrome based on your medical history and symptoms. According to Ghiassi, they may also order tests to confirm the diagnosis, including:
- Oral glucose challenge tests to measure your body's response to sugar.
- Gastric emptying tests to measure how quickly food moves out of your stomach.
Treatment
Dumping syndrome often presents a mild, temporary problem that goes away on its own within three months.
In more severe cases, though, your symptoms may last longer — 12 to 18 months — and they may have a major impact on your quality of life.
Whether your symptoms are mild or severe, dietary changes serve as the initial treatment.
Ghiassi says the following changes can effectively treat most dumping syndrome cases:
- Avoid simple sugars: This includes candy, sodas, and baked goods like cookies and cake. Opt for whole grains and other complex carbs, like brown rice and lentils.
- Eat more lean protein: Examples of lean protein include fish, chicken, beans, legumes, and tofu.
- Try smaller meals: Instead of three large meals a day, it may help to eat five to six smaller meals a day — aim to eat these meals every two to three hours.
- Eat more dietary fiber: Fiber slows down sugar absorption in your digestive system. Try switching from simple carbohydrates like white bread and pasta to whole grains like oatmeal and whole wheat. Fibrous vegetables like broccoli, cauliflower, and cabbage are also a great way to get more fiber into your diet.
- Eat healthy fats: Fatty foods like avocado, nuts, and nut butter can help slow down digestion.
- Eat slowly and chew thoroughly: Taking your time when eating helps slow down the rate food moves through your stomach.
- Avoid fluids 30 minutes before or after eating: Staying hydrated is important for your health, but drinking liquids around mealtimes can speed up your digestion.
- Try lying down for 30 minutes after a meal: This can slow down food as it moves through your stomach and help keep your blood pressure even.
If dietary changes don't resolve your symptoms, your doctor may prescribe medication:
- Octreotide can help slow down the transit time of food through your stomach and small intestine.
- Acarbose can help regulate your blood sugar if you have late dumping syndrome.
If nothing else helps your symptoms, your doctor may discuss surgical options with you, such as reconstructing parts of your stomach or reversing a gastric bypass.
Insider's takeaway
Dumping syndrome can happen after bariatric surgery, surgeries of your stomach or esophagus, and as a result of some medical conditions.
If you have any of the symptoms of dumping syndrome, it's best to check in with your doctor right away. They can make a diagnosis and guide you through the best way to manage your symptoms.
In many cases, dumping syndrome will go away on its own, but you can try to reduce or eliminate your symptoms with some simple dietary changes, such as eating five to six small meals per day, reducing your sugar intake, and increasing the amount of fiber you eat.