The best and worst foods to eat with dumping syndrome

Dumping syndrome is particularly common after gastric surgery for weight loss, but it can sometimes develop in people who've had surgery involving the oesophagus (gullet).

The condition is diagnosed based on a number of symptoms. However, tests may be needed to rule out other conditions with similar symptoms, like ultrasounds to rule out gallstones.

What are the symptoms of dumping syndrome?

Julie Thompson, Information Manager at Guts UK, says there are two forms of dumping syndrome - early dumping syndrome and late dumping syndrome.

Early dumping syndrome symptoms

This includes:

• Nausea.

• Vomiting.

• Palpitations.

• Sweating.

• Bloating.

• Cramping.

• Diarrhoea.

• Dizziness.

• Fatigue.

Early dumping syndrome happens because the rapid shift of semi-digested food into your ileum - the first part of your gut after the stomach - carries fluid with it. This sudden increase in fluid in the upper gut in turn leads to the symptoms above, largely related to body fluid suddenly being misplaced.

Late dumping syndrome symptoms

This includes:

• Hypoglycaemia (low blood sugar).

• Weakness.

• Confusion.

• Hunger.

• Sweating.

• Dizziness.

• Hypoglycaemia.

Late dumping syndrome is also known as postprandial hyperinsulinemic hypoglycaemia. After a meal (postprandial), your body produces too much insulin because the extra sugar dumped in your system causes your blood sugar to rise. The insulin then leads to an overcompensation, with a rapid drop in blood sugar (hypoglycaemia).

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The impact of dumping

Thompson says the symptoms of dumping syndrome can be severe, and they are often unpleasant.

The severity of someone's symptoms will depend on the type of surgery they've had. Some people may notice improvements to some of their symptoms over time, while others may continue to have them.

"In the instance of late dumping syndrome, which can affect blood sugars, it is not unknown for people to be blue lighted to A&E with very low blood sugars. This form of dumping can also cause people to lose consciousness. For people who have had surgery to the stomach, both dumping syndrome and having to change to eating more frequent meals were the factors that they reported affected their quality of life the most."

Thompson advises that people with dumping syndrome, especially those who are underweight or with symptoms that continue after the initial advice, should have advice from a dietician.

How can changing diet affect dumping syndrome?

Altering your diet can help stop the stomach emptying so quickly. It's also important to closely monitor how your body responds to certain foods. That will help you identify what causes problems and should be avoided.

After diagnosis, you should be referred to a dietician who can explain some of the general changes required and tailor them to your needs.

They're likely to suggest keeping a food and symptom diary to check whether the changes are working. They're also likely to monitor your weight (or ask you to monitor it) to ensure you're still getting sufficient calories. Any significant weight loss must be mentioned to your doctor (bearing in mind that you may well have had surgery to help you lose excess weight).

Modifying the diet is the main treatment for dumping syndrome, as most patients have relatively mild symptoms and respond well to this method. In rare cases where changes in diet do not ease symptoms, medication or sometimes surgery might be recommended.

What are the best foods to eat?

The speed at which sugar is absorbed can be reduced if a source of protein is eaten at the same time. Good sources of protein include:

• Meat.

• Fish.

• Eggs.

• Pulses.

• Dairy foods.

• Tofu.

Thompson also suggests foods containing complex carbohydrates, such as wholegrain versions of carbohydrates, can also help to slow absorption of the sugar in the small bowel.

"Often if someone has had surgery, they might need to eat smaller meals more frequently and they also may need additional vitamins depending on the type of surgery; hence a dietician is required to advise on what is needed."

What foods should be avoided?

Thompson says the food group that affects symptoms the most and should be avoided is simple or free sugars.

"These are types of carbohydrate which can be rapidly absorbed from the small bowel into the body and cause the symptoms of dumping syndrome. Free sugars are the sugars that are added to food," she says.

Free sugars are refined - a purified form of sugar which is very rapidly absorbed into the system. They differ from complex carbohydrates - these include high levels of fibre, which slows down absorption from the gut and gives rise to a slower, steadier increase in blood sugar.

Examples of foods containing free sugars

• Chocolate.

• Sweets.

• Biscuits.

• Cake.

• Pastries.

• Sweetened breads.

Some foods containing natural sugars that should also be considered

• Honey.

• Syrups.

• Fructose syrups.

• Coconut sugar.

• Agave.

Thompson highlights that the word 'natural' doesn't necessarily mean a food is suitable.

"Words that can indicate added sugars in food include sucrose (table sugar), fructose and glucose. Liquid forms of these sugars tend to give more rapid symptoms so sugar-containing drinks such as shakes, juices and fizzy drinks should be avoided."

How should you eat with dumping syndrome?

If you have dumping syndrome, how and when you eat can be just as important as what you eat.

Some other ways to help lessen the symptoms are:

• Eat five or six small meals or snacks a day.

• Keep portions small, such as 1 ounce of meat or ¼ cup of vegetables.

• Cut food into very small pieces.

• Chew well before swallowing, to prepare food for digestion.

• Combine proteins or fats along with fruits or starches (for example, combine fruit with cottage cheese).

• Stop eating when you first begin to feel full.

• Drink liquids 30-45 minutes after meals.

• Lie down as soon as you finish eating. This can slow the emptying of food from the stomach and prevent light-headedness.