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What to eat for Dumping syndrome?


Dumping syndrome is a condition that can develop after oesophageal, stomach or intestinal surgery. This includes bariatric surgery such as lap-band or gastric sleeve surgery for weight loss.

In short... dumping syndrome occurs when food, especially sugar, moves from your stomach into your small intestine too quickly. There are two types of dumping syndrome:


1. Early Dumping Syndrome


This is the most common type, occurring 30-60minutes after eating a meal. Early dumping results from rapid gastric emptying of hyperosmolar food content from the stomach into the duodenum (start of small intestine). This rapid emptying results in shifts from the intravascular compartment into the intestinal lumen, in turn causing...


Vasomotor symptoms:

  • Palpitations

  • Dizziness

  • Flushing

  • Fatigue

  • Desire to lie down

Gastrointestinal symptoms:

  • Early satiety

  • Nausea

  • Cramps

  • Explosive diarrhoea


2. Late Dumping Syndrome


Around 25% of individuals have late dumping and a minority have both. Late dumping typically occurs 1-4 hours after eating. It results from the rapid emptying of carbohydrates from the gastric pouch, leading to early high levels of blood glucose, which in turn stimulates the release of excessive amounts of insulin. An excess of insulin then results in your blood glucose levels dropping to super low levels; known as reactive hypoglycemia.


Late dumping symptoms include:

  • Perspiration

  • Shakiness

  • Difficulty with concentration

  • Hunger


What should you eat if you have dumping syndrome?


Diets that slow glucose absorption and reduce the insulin response are recommended for adults experiencing dumping syndrome symptoms.


Ideally, aim to:

  • consume small meals spread throughout the day (~30g carbohydrates / meal)

  • delay fluid intake ≥30 minutes after meals

  • avoid simple carbohydrates and focus on complex carbohydrates

  • choose low glycemic index carbohydrates

  • incorporate vegetables, fruits, unsaturated fats and lean protein sources

  • avoid alcohol

  • limit caffeine intake

  • eat slowly and chew food well

  • include a soluble fibre supplement (up to 15 g) with meals

  • for individuals with severe postprandial hypotension, lying supine for 30 minutes after meals may minimise the chance of low blood pressure


References

  • 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. Review. PubMed PMID: 27749997. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/27749997

  • Jenkins DJ, Bloom SR, Albuquerque RH, Leeds AR, Sarson DL, Metz GL, et al. Pectin and complications after gastric surgery: normalisation of postprandial glucose and endocrine responses. Gut. 1980 Jul;21(7):574-9. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/7000630

  • Heber D, Greenway FL, Kaplan LM, Livingston E, Salvador J, Still C; Endocrine Society. Endocrine and nutritional management of the post-bariatric surgery patient: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2010 Nov;95(11):4823-43. https://www.ncbi.nlm.nih.gov/pubmed/21051578

  • Mechanick JI, Apovian C, Brethauer S, Garvey WT, Joffe AM, Kim J, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, the Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association and American Society of Anesthesiologists executive summary. Endocr Pract. 2019 Dec;25(12):1346-359. doi:10.4158/GL-2019-0406. Epub 2019 Nov 4. PubMed PMID: 31682518. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/31682518

  • van Meijeren J, Timmer I, Brandts H, Janssen I, Boer H. Evaluation of carbohydrate restriction as primary treatment for post-gastric bypass hypoglycemia. Surg Obes Relat Dis. 2017 Mar;13(3):404-10. doi:10.1016/j.soard.2016.11.004. Epub 2016 Nov 5. PubMed PMID: 27986586. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/27986586

  • Bantle AE, Wang Q, Bantle JP. Post-Gastric Bypass Hyperinsulinemic Hypoglycemia: Fructose is a Carbohydrate Which Can Be Safely Consumed. J Clin Endocrinol Metab. 2015 Aug;100(8):3097-102. doi: 10.1210/jc.2015-1283. Epub 2015. Jun 2. PubMed PMID: 26037514; PubMed Central PMCID: PMC5393521. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/26037514/

  • Kellogg TA, Bantle JP, Leslie DB, Redmond JB, Slusarek B, Swan T, et al. Postgastric bypass hyperinsulinemic hypoglycemia syndrome: characterization and response to a modified diet. Surg Obes Relat Dis. 2008 Jul-Aug;4(4):492-9. doi: 10.1016/j.soard.2008.05.005. PubMed PMID: 18656831. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/18656831/

  • Suhl E, Anderson-Haynes SE, Mulla C, Patti ME. Medical nutrition therapy for post-bariatric hypoglycemia: practical insights. Surg Obes Relat Dis. 2017 May;13(5):888-96. doi: 10.1016/j.soard.2017.01.025. Epub 2017 Jan 16. Review. PubMed PMID: 28392017; PubMed Central PMCID: PMC5469688. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/28392017/

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