What is Dumping?
Dumping syndrome is a group of symptoms caused by rapid passage of undigested food into the small intestine. The stomach has a valve at the top and bottom, and serves as an acid-filled storage tank, breaking food intake down into small, component parts and passing it to the small bowel in small increments.
After gastric bypass, ingested food passes directly into the small bowel, mixed only with saliva, but not the stomach acid. The component parts of the undigested food remain fairly intact and therefore large.
The small intestine responds by diluting the ingested food through a process of water recruitment. The richer the food, in terms of sugar content, the more water will rush into the small intestine to dilute it. This is referred to as early dumping.
Early Dumping and Late Dumping
Early dumping occurs a few minutes to 45 minutes after eating. Symptoms are not life-threatening, but can be frightening to the unsuspecting patient. Symptoms of early dumping are:
- Weakness and fainting
- Irregular and rapid heartbeat
- Low blood pressure
- Flushing of the skin
- Shortness of breath
- Diarrhea and cramps
Late dumping occurs two to three hours after eating. It is caused by excess insulin produced in response to rapid entry of food and fluids into the small intestine. The high insulin levels lower low blood glucose level and cause symptoms including:
- Difficulty to concentrate
The diagnosis of late dumping syndrome can often be confirmed through frequent blood sampling to measure blood glucose.
You can prevent early and late dumping by avoiding the foods that cause dumping. In other words sugars, starches, and fried foods. Eat at least five to six small, evenly spaced meals a day. Take meals dry (i.e. without water or beverages, and drink fluids only between meals). Because carbohydrate intake is restricted, protein and fat intake should be increased to fulfill energy needs. Examples include meats, cheeses, eggs, nuts, toast, potatoes, and rice crackers. Milk and milk products are generally not tolerated and should be avoided.
Each person has a different tolerance, and you will discover what your personal safe foods might be throughout your post surgery life. Person A might have no problem with strawberries and person B might experience dumping every time a few strawberries are eaten and person C might be able to eat strawberries only if they are a little unripe. You will learn what your own trigger foods might be. Be aware that these may change over time as your bypass matures.
Many people say that depression is a side effect or complication of diabetes. Without discounting the association of the psychological condition with the physical one, I'm not convinced that our high and/or unstable glucose levels are directly responsible for that change in our mental state. My belief is that the unrelenting need for self-care, for following the sort of care schedules that can drive licensed, professional caregivers crazy, is what overwhelms us...