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Oesophageal Patients Association
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Dumping syndrome

Hi

I'm currently experiencing dumping syndrome it comes on after I have eaten.... Can anyone tell me why this happens? I get symptoms of dizziness fatigue nausea trembling and sweating,

When I start to feel better I feel hungry and have a snack like a lump cheese or a rich tea biscuit

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Hi Margie

have you kept a food diary? Is there any pattern to the dumping? Is this late or early dumping? If the effect is fatigue sometimes a boiled sweet will help as will a dextrose tablet.

Regards

Haward

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Hi Margie

It can be several things,

1To much sugar acts as laxative

2 Eating to much

3 Drinking and eating together especially milky drinks.

I was also led to believe that it could be caused by un digested food entering your small bowel ,again it's unrefined sugar from your food which your body then produces insulin to regulate you will get the same symptoms as hypoglycaemia or later like myself diagnosed type 2 diabetes

They are wrong as it's reactive hypoglycaemia which again is controlling your bodies intake of sugar in your food.

Treat this problem as you would diabetes and it will gradually disappear.

When you start to get light headed have glucose tablets on hand they will work wonders take 2to4 .

I hope you find this useful and informative.

Good luck Steve Y

EMail Steveandybob@aol.com

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Hi Maargie. I too have suffered from bad Dumping since my op. After 2 years I know that my dumping is caused when I take too much of something, normally sweet or milky, I.e sweets, ice-cream, cheese, cereal with too much milk. If I avoid food like this I seem to avoid dumping. Keep a food diary and see how u get on. Good luck xx

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Thank you I will keep a food diary and after reading all reply sit sounds like I am similar to you and having too much to eat with sugar

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Food diary great idea, as we may have different triggers. After the dizzy shaky episode I eat some chocolate - any excuse! Seems to work for me. I keep some boiled sweets/chocolate in my handbag at all times. It is getting better - I'm almost a year post-op. Angi xx

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There is also some information on the website here:

opa.org.uk/resources.html

This is often to do with sugar:insulin balance some time after eating, so having something sweet relieves the symptoms in the short term when your body is pumping out insulin, but the real trick is not to eat the food that creates this enormous, delayed surge of insulin, created by processed sugary food in the first place.

Things included in low GI index/load diet will tend to have a much slower rate of releasing sugar. It will sound as if you are having a diet to try and lose weight, but in many ways it is a similar process for your body.

Don't ignore this - at its worst it can lead to sudden blackouts. But it may well lead to you not eating the sort of food that you like. And trying to eat sweet food in order to put on lost weight will make the situation worse. Sorry that it sounds dramatic, but thinking of yourself as a diabetic is a sound strategy, and it can be controlled relatively easily once you start analysing the ingredients for what you are eating.

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Thank you Alan what you said is a great help to me I will be looking on the website ASAP i do worry about losing any weight not that I'm too thin etc but incase the worse case scenario if I started to lose weight so I've been trying to eat more

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Eating in order to put on weight is likely to cause you trouble! Just eat little and often taking things that don't cause you trouble, and your weight will probably look after itself. You might end up as a new, lighter normal and needing a new wardrobe though.

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It is difficult to explain this syndrome without a diagram ..but here goes :

Dumping is a mechanical problem which then can lead to a bio-chemical problem hypoglycemia.

Two stages.

The normal gullet/stomach arrangement is similar to an hockey stick [ resembling the letter 'J' ] .Food descends [not by gravity but by waves of squeezing ] the long thin pipe and lands at the bottom of an expandable bag.As the bag fills up and expands the level of chyme [liquid food combined with digestive juices] remains below the level of the outlet [the pyloric sphincter] The muscular walls of the bag churn away until sensors detect that the meal has reached a suitable state of digestion whereupon the pyloric sphincter relaxes momentarily and a small dollop of chyme is extruded through and on down around the bend into the duodenum.

The size of each dollop is about one percent of the meal and the frequency of passing is about once a minute so it takes approximately one hour and forty minutes for the entire meal to be passed. All this is variable depending upon how much of which foods were consumed.

It is easy to see that when the stomach has been cut down to about the size of an orange and then pulled up high into the chest the foregoing original elegant arrangement has been completely destroyed.

So if you overload the new relatively tiny stomach it's retention abilities are over-stretched and the entire contents can suddenly avalanche down.The pyloric sphincter valve cannot be relied upon to act as as a stopper since it is under tension;having been pulled up with the stomach and it's regulating nerve supply has been cut wholly or partially.

This tendency to avalanche is exacerbated by (1) eating too much (2) eating too fast (3) having too much lubrication, that is liquids and (4) imposing strain by moving about.

Now for stage two.

Waiting downstream in the duodenum is a sophisticated set of sensors connected to the brain.

Crudely put when a larger than expected 'dollop' arrives these sensors send 'panic' signals calling for for instance extra detergents to deal with fats which results in the gall bladder contracting and supplying a shot of bile.Via a separate pathway and in anticipation of the breakdown of that extra food and its absorption into the blood stream insulin is secreted.This response is stronger if the 'avalanche' has an high carbohydrate content.

The action of insulin is to cause cells throughout the body to extract sugar from the blood and store it ultimately as fat.

If at the onset of dumping blood sugar levels were already low [ say you had had a walk and it was several hours since the last meal ] then the prematurely high levels of insulin can deplete blood sugar to a point where coma,convulsions and even death can ensue.

A characteristic of an "hypo " is that we become highly irrational and aggressive.Thus by the time that stage is reached it is very difficult for a third party to intervene to rescue you.

The restorative antidote is sugar,immediately and in any form. Sugar lumps ,Lucozade ,whatever ...personally I rely on Werther's Original taken the moment that the presentiment of being light headed and ill-at -ease is recognized.

Thus the trigger factors are :- Volume/Speed/Content/Liquidity/Movement.

You can permutate these in any combination to suite your personal circumstances.

Personally I find that I can eat and drink any reasonable volume of anything provided I remain seated for at least 100 minutes after the last mouthful. Conversely if I bolt down half a sandwich[carbohydrates] and then get in the car to drive somewhere I will be Hypo within the next two hours.

I have the record of ambulance admissions to A&E and the broken bones to evidence the penalties for getting that balance wrong !

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Gutlesswonder thank you so so much I truly appreciate your response to my question it is so informative i really appreciate you taking the time to write all that to help me and you certainly have helped a great deal as I now have a better understanding so thank you again

Margie

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That is a great and clear explanation, Gutless. Can you please confirm that you sit for 100 minutes. That seems a very long time if you are eating approximately every 2 hours, especially if you are the person who, like me, prepares the food!

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Hello sms80

Thanks for the feedback ( or should that be 'reflux' ?! )

I will respond within 2-3 days as presently away dealing with a family matter.

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Dumping is literally a real pain but it can be controlled. I found the best advice was from the OPA (Alan has commented here) - but there are also lots of useful tips on their website. If it does cause you pain -I found a a hot water bottle helps to relieve the symptoms too! It will get better as you get to know what is causing it for you but it does seem to be something we all have to get under control and continue to monitor.

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Thank you gutless, (what a name), best explanation I have ever read. I also get massive amounts of saliva forming which gives advance warning.

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Thank you everyone for your replays to help with my question

Margie

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My own experience is this. I have kept a food diary on two occasions and for multiple reasons. After the operation I found that eating could lead to fatigue , muscle cramp or dumping. I kept a food diary then to see whether there was any pattern to the follow on from eating. I couldn't find any. I also wanted to be sure that I was eating a varied diet. I was - my surgeon commented that he was pleased to find me washing down foie gras with a decent champagne. Because there was no pattern , and , at this stage , I was eating 4-5 meals per day , I was more inclined to experiment with food , and to ignore one offs or even two offs (advice I've seen repeated at a recent OPA meeting) and to persevere , to retrain the system. After my operation the very idea of , say a black pudding sandwich , would have turned me pale , but nowadays I look forward to this sort of grub. The same is true of steak. One of my targets was steak and chips. It took months but I got there. Occasionally that has consequences but most of the time it doesn't.

Nowadays I still find no pattern although my partner thinks that eating too quickly is the main cause of wind and fatigue and dumping ; all of which I still get occasionally. I vary eating habits and patterns , sometimes eating four meals per day , sometimes three. I've managed larger meals , washed down with wine , and I have had bad experience just with a coffee and cake.

We are all different and we all have to find our own right balance or own way to live. Finding it can be hard , even painful , and it takes time but trying to get as far back to what was normal as possible was what I aimed for.

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Thank you I have had episodes when I've eaten foods that haven't effected me before I agree with what you say we are all different. May I ask what wine you drink? I ask as I occasionally like to have a glass of white wine if we go out for a meal or should I say starter lol I have found that wine is causing acid reflux/heartburn I always ask if they have a less acidic wine but I get strange looks lol

Margie

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Hi Margie

I tend to like Pinot Noirs and Sauvignon Blancs. And sweet wines. And port! And champagne......oh dear ; I sound like an old soak but it really isn't that bad. I've seen advice that sherry can be good for you and help you eat but I am not a sherry fan

Haward

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Thanks to GutlessWonder above for the best description/explanation I have ever read of the condition.

I haven't had an oesophagectomy but following a Collis-Nissen fundoplication revision surgery earlier this year have been experiencing DS frequently. I am following the advice - particularly about small portions. (Typically less than half sized "normal" portions.) However, I find it difficult to eat more frequently to keep the energy up. Often it's just the thought of food and its possible consequences that prevent me.

I have just returned from a gruelling cycle challenge over the Andes and must congratulate the chefs who ensured I had nutritional small meals but although I attempted to keep energy levels up with nutrition bars, I found it very difficult. (I guess I was too stubborn. I was told it may take a year for full fitness recovery but insisted on doing this after just 5 months.)

But has anyone any tips on keeping my energy levels up?

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Well done on cycling through the Andes! I am speculating that anything normally taken to give energy must by definition have a high sugar content or high carbohydrate content that would convert to sugar? Perhaps diabetic energy bars (if they exist?). So the holy grail would be either something that gave energy that was very slow at changing sugar:insulin levels; or alternatively some way of timing the intake so that your expenditure of energy matched the timing of exactly when your body's activity needed it.

I think this is a specialist dietician's issue. I will ask for advice!

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Thanks Alan,

On the cycle we did keep well nourished with energy bars between meals but I did flag (and had to resort to riding the support bus for a couple of short periods). Back home it takes some motivation to chew those cardboard tasting bars and I don't have the energy to even cycle round the block. But I am seeing my GP next week.

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The advice I received was: consume low GI foods: porridge, homemade flapjacks (with low sugar), multigrain bread, nuts, seeds, nut bars would be a good place to start. Bananas are also a good suggestions! Very dark chocolate with little/no sugar.

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The early months are the difficult ones. I was antisocial and wouldn't eat out or visit friends for meals, eventually I 'trained 'people to recognise my eating limitations. I adopted a small plate for my serving, that way I didn't overeat. Friends made meals where we could serve ourselves and over time I have trained some local eateries to offer smaller meals, I even have a Breakfast named after me. The smallest and cheapest on the menu of course, but very popular with local pensioners. The local pizza place makes a very small pizza range now, but I still need a doggy bag, (I mean breakfast). Drinking and eating together is a problem as food and drink will fight for the same space in our small stomachs, hence dumping. In my case I have a single whisky well before the meal or if it is one of those long drawn out affairs I make a glass of wine last a long time. We each have to adapt as best suits us, but don't give in, there are ways and means to have a reasonable life.

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Good Day, Margie,

I have suffered dumping since my operation # Years ago, I have six small meals a day, this seems to help.

Stress tends to bring it on as does pain. I have had up to 3 episodes in day and have many admittance to hospital and notice that nursing staff say I'm Diabetic, because they are not taught about dumping syndrome. This can be dangerous as you can imagine, Can anyone tell my this is? Even Doctors! WHY???

Chin up Love, we are alive and lucky this is our only problem.

Terry

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You are right, Terry, that eating little and often will help. The condition will be equivalent to diabetes because the surges of insulin caused by food, especially sweet/carbohydrate, travelling quickly through your system will affect the sugar:insulin balance. And if you have the problem at a severe level for long enough you may get what they call insulin resistance. It can effectively make you diabetic. So some people find having a sugar:insulin balance meter helpful, as used by diabetics. There are sometimes wide swings in the readings before and after you start getting a dumping syndrome attack. So adopting a diabetic diet, where your food is restricted to terms that release sugar only slowly, can help. It is the sudden surges / spikes that do the damage.

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I have found that eating very sugary food would cause that. Therefore I stay away from anything with a high amount of refined sugar or processed food. I cannot not eat a candy bar anymore as that really does it. I drink coconut milk so do not do tons of dairy products. I think the foods we eat causes it. I have not had it for a few months since I have been conscious of my eating. I hope it gets better for you!

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Thanks to the friends here, I now feel quite knowledgable on the subject of dumping syndrome - and wish I'd realised about the insulin rush before. I now find a couple of dextrose tablets if I start to feel the symptoms work wonders.

I saw my GP yesterday. I'd originally made the appointment a couple of weeks ago when I was feeling particularly rough. She was impressed I understood and was managing the condition. (And I was impressed she knew as much about it.)

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Hi Margie

One of the most common symptoms after our type of surgery ...

There are two types - early and late - early occurs soon after having eaten and is a sugar rush to the metabolism without the related insulin. You will get dizzy, nauseous and sweat. It will last 30mins to an hour. It's a bit like short term diabetes but the insulin will soon kick in. I find going somewhere cool and dark for 30mins helps. Late dumping starts after approx 2 hrs and is because you are making too much insulin for the sugar hit that has already passed. A tea and biscuit or a sweet will help then.

Hope this helps

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