Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Understanding Dumping Syndrome
Dumping Syndrome is a condition wherein your food moves too quickly from your stomach to the duodenum (first part of the small intestine). As a result, within a few minutes to a few hours of taking food you would experience symptoms like diarrhea and cramps.
It may also occur following
– stomach surgery wherein a part or total stomach has been removed or
– if you would have had stomach bypass surgery to lose weight
Types of Dumping Syndrome
Basically, there are two types of dumping syndrome based on when your symptoms start. They are as explained below –
1. Early Dumping Syndrome
It is estimated that 75 % of the dumping syndrome cases come under this category. This condition happens and the symptoms appear 10 to 30 minutes after one has taken the food.
2. Late Dumping Syndrome
This is found in fewer people in comparison to the early dumping syndrome. This happens 1 to 3 hours after you have consumed food.
We should know that each of these dumping syndromes will have a different set of symptoms. Some people will have mixed conditions i.e. both early and late dumping syndrome.
Symptoms of Dumping Syndrome
Symptoms of early dumping syndrome
Below mentioned are the symptoms of early dumping syndrome –
– nausea
– vomiting
– diarrhea
– abdominal cramps
The symptoms of this type of dumping syndrome typically start 10-30 minutes after eating food.
Other symptoms can also be present and include – bloating / fullness of abdomen, flushing of the face, dizziness, sweating and heart rate.
Symptoms of late dumping syndrome
Below mentioned are the symptoms of late dumping syndrome –
– weakness
– sweating
– dizziness
– hunger
– fatigue
– confusion
– shaking
– fast heart rate
These symptoms typically appear 1-3 hours after eating food. These symptoms are caused by low blood sugar. One might have a combination of both early and late symptoms of dumping syndrome.
Causes and pathogenesis of Dumping Syndrome
Normal physiology – We eat food. This food gets partially digested in the stomach and then over a period of several hours moves from stomach into the intestines. When the food reaches the intestines the nutrients from the food are absorbed. The digestive juices of the intestines further break down the food.
Dumping syndrome – Here the events take place too fast. In this condition the food moves too quickly from the stomach to the intestine than what is expected of.
Coming to the causes and pathogenesis –
Early dumping syndrome
Stomach suddenly pushes the food into the intestines
↓
Movement of plenty of fluid from bloodstream into the intestine
↓
Increase of fluid levels in the intestine
↓
Results in diarrhea and bloating
↓
Release of some substances by your intestines
↓
Results in increased heart rate and lowering of blood pressure
↓
Results in symptoms like dizziness and fast heart rate
Late dumping syndrome
Food moves to the intestines from the stomach 1-3 hours after having eaten the food
↓
Starches and sugars get increased in the intestines
↓
Blood sugar level rises due to extra sugar
↓
Results in increased release of insulin from the pancreas to move sugar from the blood into the cells
↓
The extra insulin released by the pancreas causes the blood sugar levels to drop too low (hypoglycemia)
Dumping syndrome caused by surgery
Surgery to remove part of stomach or entire stomach
↓
Reduces the size of the stomach / bypasses the stomach
↓
Dumping syndrome
↓
Food moves from stomach to small intestine more quickly than usual
Also, the surgeries that affect the way the stomach empties the food into the intestine can also cause dumping syndrome
Below mentioned types of surgeries can cause dumping syndrome –
– Gastrectomy
– Gastric bypass
– Esophagectomy
Treatment principles and options
The treatment for dumping syndrome varies from person to person and depends on the condition and severity of the disease. The treatment may include one or more medications, dietary changes and surgery.
Diet for Dumping Syndrome
Making some changes in the diet we take might help in easing the symptoms of dumping syndrome. The below mentioned may be included.
Swap –
– big (2-3) meals with multiple (5-6) small meals
– to whole grains (oatmeal, whole wheat) from simple carbohydrates (pasta, white bread etc)
Avoid or limit – the quantity of –
– Soda
– Candy
– Baked foods
Eat more – protein containing foods like –
– Fish
– Chicken
– Tofu
– Peanut butter
Include more fibers in the diet. Fiber supplements can also be included. Fibers will help in slow absorption of carbohydrates and sugars in the intestines.
No fluids – within 30 minutes before or after taking meals.
Chew – make sure to chew the food thoroughly before swallowing it. This will make food easier to digest.
Adding – guar gum or pectin to the food. This will thicken the food which will in turn slow the rate at which the food moves into your intestine from your stomach.
Certain foods exacerbate dumping syndrome. Avoiding such foods would relieve the symptoms of the disease.
Inclusive Foods – The below mentioned foods shall be included in the diet –
– Fresh vegetables that are cooked properly
– Raw vegetables and fruits, dried beans (tolerance for these foods shall be accessed)
– Fruit juices which are not sweetened
– Cereals which are not sweetened
– Canned fruits which are not sweetened
– Sugar free drinks and desserts
– Caffeine free drinks
– White potatoes, sweet potatoes
– Eggs, beef, pork, seafood, poultry
– Cheese, butter, margarine
– Pasta, salad dressing
– Rice
– Salt, mild seasonings
Foods which are less tolerable and can aggravate the symptoms are as listed below –
– Alcohol
– Caffeinated drinks
– Some vegetables which produce gas and are also intolerable like onions, cabbage, broccoli, cauliflower etc.
– Cereals which are sweetened
– Doughnuts, pancakes, pastries (sugar baked breads)
– Candies, cookies, cakes, syrup,
– Chili and pepper sauce
Problems with nutrition – This disease can hamper the body’s ability to absorb the needed nutrients from food. This will cause a nutritional deficit and related symptoms. One should bring it to the notice of the doctor and inquire if he or she needs nutritional supplements to combat this condition.
Medications
Octreotide (Sandostatin) – is often prescribed by the doctor for more severe dumping syndrome. This slows down the emptying of the stomach into the intestine. It can be taken as an injection. This drug comes with its side effects and they shall be monitored.
Acarbose is yet another medication used for treating this condition. It helps in relieving the symptoms of late dumping syndrome. There are side effects of this drug too.
Surgery
Surgery will be the ultimate option when no treatments or medicines help in relieving the symptoms of this condition. But it isn’t always successful in reversing the condition.
Complications
Dumping syndrome is a complication of stomach bypass or stomach reduction surgery. Below mentioned are the other complications related to this surgery –
– Poor nutrition due to poor absorption of nutrition
– Osteoporosis due to poor absorption of calcium
– Anemia – due to poor absorption of vitamins / iron
Report immediately to your doctor and seek help if –
– You develop dumping syndrome symptoms including nausea, vomiting, abdominal pain, bloating, diarrhea, after meals
– If you have history of esophageal or stomach surgery and develop the above said symptoms
– If your symptoms are not getting better with dietary changes or medication
Note: this syndrome can occur many years after you have undergone surgery.
After having thoroughly evaluated your symptoms, your doctor may recommend you to get some tests which would confirm dumping syndrome and at the same time help to rule out other conditions.
Dumping syndrome can cause malnutrition and subsequently cause loss of weight to a great extent. You might need the help of a dietician in this case.
Diagnosis
This condition can be diagnosed on the basis of your medical history and symptoms. Below mentioned tests may be needed to confirm the diagnosis.
Blood sugar test
Gastric emptying test to measure the time taken by the stomach to empty the food
Upper GI Endoscopy or Upper GI series – to rule out other possible medical conditions
Preventive measures
There is no way to prevent this condition especially when it occurs after stomach or esophageal surgery.
Certain changes made in diet (post surgery) could possibly reduce the risk. One needs to eat 5-6 small servings of food in a day rather than taking 2-3 large meals. One shall also avoid or limit sugar intake, drink a lot of fluids with meals and also consume more fibers and proteins.
Early Dumping Syndrome most often gets better within a few months even without treatment. Making dietary changes and regular intake of prescribed medicines would help to a great extent. Surgery might be needed if symptoms do not improve.
Study – Patients who have undergone curative treatment for esophageal cancer experience reduced HRQL (Health Related Quality of Life) from early and late dumping symptoms at one year after surgery that indicate clear implications for clinical routine. This would require medical support and additional dietary counselling.
Study – Dumping Syndrome (DS) and Post-Bariatric Hypoglycemia (PBH) are frequent complications of Bariatric surgery. A study showed that 22 out of 47 bariatric patients experienced dumping syndrome complaints (DS+) during a Mixed Meal Test (MMT). The DS+ group had lower blood glucose values compared to the DS- group during MMT. This showed that DS and PBH might share a common etiology.
Ayurveda Understanding of Dumping Syndrome
Samana Vayu and Pachaka Pitta jointly operate in the stomach and upper intestine along with Kledaka Kapha to receive, digest, bifurcate the digested food into nutritive and excretory products, enable absorption and distribution of nutrition to every corner of the body and to propel the excretory products down to the colon for excretion. Individual or relative disturbance or imbalance of these doshas would cause either a delayed or early dumping of food leading to dumping syndrome.
Diseases like ajirna, agnimandya, adhmana, alasaka, vilambika, udavarta, atisara and grahani either cause, predispose or trigger symptoms similar to those of dumping syndrome.
Treatment includes avoiding the causative factors, following food discipline and etiquettes and promptly treating the causative doshas or diseases causing dumping syndrome.
Related Reading – ‘Dumping Syndrome – Ayurveda Understanding’
