Dumping Syndrome after Gastric Bypass
A number of patients inquire at our office about symptoms they begin to have 12-18 months after gastric bypass. They describe symptoms of feeling light headed, dizzy, nauseated, sweaty, or achy all over with crampy abdominal pain which occurs about 45 minutes to 1 hour after a meal. This is called “late dumping syndrome†and is caused by a low blood sugar in response to carbohydrates in the meal.
Most patients are aware of “dumping syndrome†which may occur in patients who consume sweets or desserts after gastric bypass surgery. Dumping syndrome actually occurs in 2 different forms: Early and Late.
Early dumping syndrome is due to eating sweets which are high in sugar. This occurs usually immediately after eating something like ice cream and results in nausea, vomiting, diarrhea, and possibly lightheadedness or feeling faint. Early dumping is due to a large sugar load hitting the intestine all at once, so the bowel pulls in water from your blood stream to try and dilute the sugar. As you rapidly lose water from your blood your blood pressure drops so you feel faint and sweaty. As the GI tract fills with water and distends the bowel you begin to cramp, become nauseated, vomit, or have diarrhea. It will last 1-2 hours then go away on its own. You only think you’re going to die. This will occur in around 90% of patients after gastric bypass. Unfortunately it’s not in everyone, and some patients can eat sweets after surgery. The treatment is to not eat sweets again.
Late dumping begins to occur about 12-18 months after gastric bypass surgery, and it is due to a low blood sugar. The GI tract and intestine are very sensitive to carbohydrates after weight loss surgery. If you eat a meal which is high in simple carbs like mashed potatoes, and especially if you drink fluids with the meal, you may experience adverse symptoms. Typically about 45 minutes after a meal you feel sweaty, lightheaded and nauseated. This is due to the carbohydrates making your blood sugar increase rapidly after a meal and extra insulin is produced in response to the meal. The insulin then makes the blood sugar drop too low and causes the symptoms. Treatment is to drink a small amount of orange juice or eat a couple of lifesavers to raise the sugar slightly. The long term solution is to eat a diet which is high protein and low carbohydrate and avoid all simple carbs which are white foods (potatoes, rice, bread, pasta) and don’t drink fluids with the meal. The symptoms almost always go away with time by year 2 or 3 post-op.
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