This dietary information is for patients who have had part or all of their stomach removed. It is important to modify old eating habits to avoid unpleasant symptoms.
What is dumping syndrome?
After stomach surgery, some patients may have what is commonly known as dumping syndrome. Without a stomach to hold the intake of food and fluids, there is no way to regulate the amount of food entering the intestine. You no longer have a reservoir to hold food so that it can gradually enter the small intestine. Instead, after a meal, the food may be “dumped” too quickly into the bowel. This may result in cramping and pain. When sugars and starches that you have eaten are dumped into the bowel, they may act like sponges, rapidly absorbing water from the body into the intestine. This leads to a number of symptoms including diarrhea, low blood sugar and feelings of weakness or dizziness.
Up to 75 % of patients who have had a partial or total gastrectomy may experience dumping syndrome. Symptoms of dumping syndrome are more common in the immediate post-operative period and often subside over time.
There are two phases of dumping syndrome; early dumping phase and late dumping phase.
Early Dumping Phase
- Occurs 15 to 30 minutes after eating
- Caused by rapid entry of food into the small intestine
- Symptoms include nausea, vomiting, cramps, abdominal pain, diarrhea, and feeling full after eating only a small amount of food. Weakness, flushing, dizziness and sweating may also accompany early dumping syndrome.
Late Dumping Phase
- Occurs 90 minutes to 3 hours after eating
- Caused by a rapid rise in blood sugar and then a rapid decrease in blood sugar
- Symptoms may include sweating, fast heart-rate, weakness, feeling tired, anxiety or mental confusion
General Guidelines to Prevent Dumping Syndrome
- Eat six to eight small meals daily to avoid eating too much at a time. You may be able to tolerate larger portions over time, but keep servings small at first.
- Have a protein food with each meal and snack such as meat, poultry, fish, eggs, milk, cheese, yogurt, nuts, tofu or peanut butter.
- Do not drink liquids with meals. Drink 30 to 60 minutes before or after meals. Eventually you may tolerate small amounts of liquid with meals.
- Limit high-sugar foods such as soda, juice, Ensure, Boost, cakes, pies, candy, doughnuts, cookies, fruit cooked or canned with sugar, honey, jams, jellies.
- Choose high-fiber foods when possible. These include whole wheat breads and cereals, whole wheat pasta, fresh fruits and vegetables.
- Choose foods high in soluble fiber. This includes apples, oats, beets, Brussel sprouts, carrots, spinach and beans.
- Try adding a serving of fat to meals and snacks such as butter, margarine, gravy, vegetable oils, and salad dressings. Fats slow stomach emptying and may help prevent dumping syndrome.
- Some people find that avoiding very hot or very cold foods help.
- Chew foods well and eat slowly. Try to relax while eating.
- Lying down right after eating may lessen symptoms.
The chart below lists foods that are better or less tolerated bypeople following gastrectomy. The foods in the “Better Tolerated Foods” list are less likely to cause dumping syndrome than the foods in the “Less Tolerated Foods” list. The “Less Tolerated Foods” are known to cause dumping syndrome in some people. It takes time and experimentation to figure out what works best for you. Keeping a food journal to track the time of day, food intake including quantity, and symptoms when they occur may be helpful in identifying problem foods and habits.
|Food Group||Better Tolerated Foods||Less Tolerated Foods|
|Breads/Grains||Whole grain breads, muffins, bagels, and crackers; unsweetened dry or cooked cereals, rice, pasta, barley, potatoes, pretzels, popcorn, crackers||Doughnuts, sweet rolls, muffins, coffee cake, pastries, and sugary cereals.|
|Fruits||Fresh fruit, frozen or canned fruit without heavy syrup/ added sugar, fresh- frozen fruit||Dried fruits, canned fruits in syrup, sweetened juice, canned pie fillings|
|Vegetables||All vegetables fresh, frozen or canned||Vegetables with added sugar or sweetened sauces|
|Meats and Protein (with each meal and snack of 1-3 oz. meat, fish, poultry or cheese, 1/2 cup tuna or cottage cheese, 1-2 eggs, 1 cup plain or artificially sweetened yogurt, 1-2 tsp. peanut butter)||Meats, poultry, fish, seafood, peanut butter, nuts, dried peas and beans, eggs, cheese, cottage cheese, milk, buttermilk, diet pudding, light or plain yogurt||None|
|Fats and Oils||Butter, margarine, oil, salad dressing, mayonnaise, cream, cream substitutes, sour cream, cream cheese, bacon||Sweetened cream cheese, honey butter, salad dressings made with honey|
|Sweets and Desserts||Sugar-free pudding, sugar-free gelatin, sugar-free jellies, sugar-free syrup, plain cake and cookies (no frosting), no sugar added ice cream, artificial sweetener, sugarless gum, fruit preserves and low sugar jelly||Regular ice cream and popsicles, cakes, pies, frostings, cookies, jellies, jams, syrup, gelatin, high sugar desserts, sherbet, sugar, candy, molasses, sweetened toppings|
|Beverages (8-12 Cups)||Water, milk, coffee, tea, soup, broth, artificially sweetened carbonated beverages and flavored drinks such as Crystal Light®||Sugar-sweetened beverages, regular soda, lemonade, Kook-Aid, Gatorade, chocolate milk and milkshakes|
Sample Meal Plan
The chart below gives an example of six small meals throughout the day. It is important to remember to drink liquids between meals.