Food that moves too quickly from your stomach into your duodenum, the first part of the small intestine, can cause a group of symptoms called dumping syndrome, and its two forms are split by timing. Early dumping syndrome brings symptoms within 30 minutes after eating a meal. Late dumping syndrome brings them 1 to 3 hours after a meal, and they are caused by low blood sugar, also called hypoglycemia. If dumping syndrome is behind your episodes, you can tell which form they match by when they start: one that feels like a sugar crash about twenty minutes after eating matches the early form's timing, not the late form's low.
Whether twenty minutes is long enough for a blood sugar low
A low blood sugar from dumping syndrome comes later than twenty minutes: in late dumping syndrome it arrives 1 to 3 hours after a meal and, experts think, follows an earlier change in the gut. When food reaches the small intestine too fast, your digestive tract releases more hormones than normal, and fluid moves from your bloodstream into your small intestine. Those two changes are thought to cause the early symptoms. The extra hormones may also make your pancreas produce too much of the hormone that lowers blood sugar, which can lead to the late form's low and its symptoms.
The two forms side by side:
| Early form | Late form | |
|---|---|---|
| When symptoms start | within 30 minutes after eating a meal | 1 to 3 hours after eating a meal |
| Cause | extra gut hormones and fluid moving into the small intestine, experts think | low blood sugar |
| Symptoms may include | digestive symptoms, such as diarrhea, feeling uncomfortably full or bloated, nausea, pain and cramping in your abdomen, and stomach growling or rumbling sounds. Other symptoms: feeling light-headed or fainting; feeling tired or needing to lie down; flushing, or reddening of your face, neck or upper chest; a fast or irregular heartbeat; headache; sweating | feeling light-headed or fainting; feeling shaky or jittery; feeling tired; a fast or irregular heartbeat; trouble concentrating; sweating; weakness |
| How common | the more common form | about 1 in 4 people with dumping syndrome have the late form alone |
Sweating, a fast or irregular heartbeat, light-headedness or fainting, and tiredness can come with either form, and symptoms may vary from person to person. Some people have both forms, so an episode at twenty minutes and another at two hours can happen to one person. The two forms are defined by when symptoms start after a meal, so for each episode, write down how long after eating the first symptom came, and show that list to your own doctor.
Whether dumping syndrome can happen without stomach surgery
Dumping syndrome can happen without stomach surgery, although surgery of the stomach or esophagus causes rapid stomach emptying and dumping syndrome more often than anything else. The operations that may lead to it include:
- weight-loss surgery, such as gastric bypass and gastric sleeve surgery
- esophagectomy, which removes part of the esophagus
- fundoplication, which sews the top of the stomach around the esophagus
- gastrectomy, which removes all or part of the stomach
- vagotomy, which cuts the vagus nerve in the stomach so that the stomach makes less acid
Rapid stomach emptying sometimes occurs in people who have not had stomach surgery. For example, it may occur in people who have recently developed diabetes, especially type 2 diabetes, in people with duodenal ulcers, and in people whose pancreas does not make enough of certain enzymes, so that digestion suffers, a condition called pancreatic exocrine insufficiency. In some cases a person has rapid stomach emptying and dumping syndrome and the cause is unknown.
If you have had one of those operations, even long ago, tell your own doctor which one and when. About 1 in 10 people who have stomach surgery develop dumping syndrome, and it is more common after gastric bypass than after other types of weight-loss surgery (see Had a sleeve or bypass? Bring the operation to any new weight care).
Low blood sugar can also happen without diabetes, although that is rare, and its causes can include liver disease, kidney disease, hormone deficiencies, certain types of weight-loss surgery, and some medicines, such as certain heart medicines and antibiotics. When some types of weight-loss surgery cause it, the low usually comes 5 or more years after the surgery.
What changes at the table if it is dumping syndrome
Treatment starts at the table, with changes to how and what you eat, the first step in treating dumping syndrome, and many people with it have mild symptoms that get better over time with simple changes in eating and diet. If new eating habits have not helped, a doctor may prescribe medicines, and in some cases dumping syndrome is treated with surgery.
To change how you eat, a doctor may recommend:
- eating six small meals a day instead of three larger meals
- waiting to drink liquids until at least 30 minutes after a meal
- lying down for 30 minutes after you eat a meal
The changes to what you eat go beyond sugar. A doctor may also recommend:
- eating more protein, fiber and fat
- eating fewer carbohydrates, and choosing foods with complex carbohydrates, such as whole grains, fruits and vegetables, over foods with simple sugars, such as candies, cookies, sugary drinks and other foods and drinks with added sugar
- avoiding milk and milk products
- adding pectin or guar gum, plant extracts used to thicken food, to what you eat
Avoiding food to stay clear of the episodes carries its own risk. Some people with severe dumping syndrome may avoid eating to prevent symptoms, and that can lead to weight loss and malnutrition. If you have started skipping meals because of the episodes, tell your own doctor.
How a doctor works out what the episodes are
A doctor reviews your medical history, including any surgery of the stomach or esophagus, and typically works out what the episodes are from your symptoms, sometimes with a scoring system that gives points to different symptoms or a special questionnaire for you to fill in. Those can help a doctor find out whether you most likely have dumping syndrome or a different health problem.
To confirm it and rule out other conditions with similar symptoms, a doctor may order tests. For an oral glucose tolerance test, you fast for at least 10 hours beforehand, taking only water, and then drink a solution that contains glucose, a form of sugar. A health care professional takes blood samples and checks your blood pressure and heart rate before you drink it and then every 30 minutes for up to 3 hours, a span that takes in both windows. The samples measure your blood sugar and your hematocrit, the share of your blood made up of red blood cells, which rises in dumping syndrome because fluid moves out of your bloodstream into your small intestine after a meal.
A gastric emptying scan measures how fast your stomach empties. You eat a bland meal, such as eggs or an egg substitute, containing a small amount of radioactive material, and a camera outside your body scans your abdomen several times over up to 4 hours to track it. A doctor may also order other tests, such as an upper GI endoscopy or an upper GI series, to examine your esophagus, stomach and small intestine and look for signs of other health problems.
When to call 911 during an episode
Signs of low blood sugar include shaking, sweating, a fast or pounding heartbeat, hunger and unclear thinking, and eating or drinking something with carbohydrates can help a mild or moderate low. If those signs do not improve after you have eaten a snack that has sugar, either get a ride to the emergency room, without driving yourself, or call 911.
A person with diabetes or low blood sugar who becomes less alert or cannot be woken up needs medical help right away, so call 911 for them.
If you faint during an episode, the reasons for someone with you to call 911 include these, even if you have fainted in episodes before:
- you do not become alert within a couple of minutes
- you are over 50 or pregnant
- you have diabetes
- you have chest pain, pressure or discomfort
- you have a pounding or irregular heartbeat
Even when it is not an emergency, contact your own doctor for an appointment as soon as possible if you have never fainted before, if you faint often, or if you have new symptoms with fainting.
If episodes pass on their own but keep coming back after meals, have your own doctor look into them at a booked visit. Your care team can hear about them too, if NicoCares coordinates your weight care: write to them in Spruce, which you join from an invitation emailed to you, and describe the episodes and any eating change a doctor has recommended. No answer time comes with a Spruce message, so in an emergency like those above, call 911 or get a ride to the emergency room first, and write once it is over.
