Dumping Syndrome Diet

DUMPING SYNDROME DIET

Description
The diet is modified to prevent the rapid introduction of a hyperosmolar solution into the proximal jejunum (“dumping”). Several nutrition strategies may be employed, including altered macronutrient composition, size and timing of meals and avoidance of certain food constituents. The diet limits beverages and liquids at meals, limits the intake of simple carbohydrates, and is high in protein and moderate in fat.

Indications
The dumping syndrome is a complication that may result from:

the reduced storage capacity of the stomach following gastrectomy
any procedure that interferes with the pyloric sphincter or compromises the reservoir function of the stomach

The “dumping syndrome” occurs in response to the presence of undigested food in the jejunum. When this occurs, plasma fluids shift into the intestine area to equalize osmotic pressure, causing a drop in blood volume. Symptoms vary among individuals and may consist of the following: abdominal bloating, nausea, cramps, diarrhea, weakness, diaphoresis and tachycardia. In most cases, symptoms appear within 15 to 30 minutes after a meal. The secretion of gastrointestinal hormones has also been implicated in causing hypotension and palpitations (1,2). Some postgastrectomy patients experience “late postprandial dumping syndrome” characterized by hypoglycemia 1 to 2 hours after a meal.

Contraindications
If patient has malabsorption of fat, do not increase fat intake with the dumping syndrome diet.

Nutritional Adequacy
The diet can be planned to meet the Dietary Reference Intakes (DRIs) as outlined in the Statement on Nutritional Adequacy. The adequacy of the diet depends on the extent of the surgery and the individual’s food tolerance. After gastric surgery some patients experience malabsorption, which may be specific for macro- or micronutrients. Vitamin and mineral supplementation may be necessary, depending on the extent of surgery and whether the dumping syndrome symptoms persist (1).

How to Order the Diet
Order as “Dumping Syndrome Diet.” One or more features of the diet may be individually ordered, eg, Sugar in Moderation Diet, 120 cc fluid ½ to 1 hour before or after meals, 5 to 6 small meals, Lactose-Controlled Diet, Low-Fiber Diet, or other strategies listed under Planning the Diet.

Planning the Diet

Simple carbohydrate (lactose, sucrose, and dextrose) consumption is kept to a minimum to prevent the formation of a hypertonic solution and the subsequent osmotic symptoms, as well as to prevent late hypoglycemia. (See Sugar in Moderation Diet.) Complex carbohydrates may be included.
Taking liquids with meals is thought to hasten gastrointestinal transit. Consume adequate amounts of liquid throughout the day in small amounts at a time (3). Carbonated beverages and milk are not recommended in the initial stages of the diet.
Smaller, more frequent feedings (5 to 6 per day) are recommended to accommodate the reduced storage capacity of the stomach and to provide adequate nourishment.
Lactose, especially in milk or ice cream, may be poorly tolerated due to rapid transit time, so should be avoided. Cheese and yogurt are better tolerated. A Lactose-Controlled Diet may be beneficial. (See Lactose-Controlled Diet.)
Proteins and fats are increased as necessary to meet energy requirements. An increased fat intake also delays gastric emptying. A moderate fat intake (30% to 40% of kcal) and high protein intake (20% of kcal) are recommended (3).
Lie down and avoiding activity for an hour after meals may lessen symptoms (3).
If adequate caloric intake cannot be provided due to steatorrhea, use medium chain triglyceride products. (See Medium Chain Triglycerides.)
Pectin may be utilized in the diet regimen to slow gastric emptying time (2,3).

Reference
1. Postgastrectomy Diet. Manual of Clinical Dietetics. 6th ed. Chicago, IL: American Dietetic Association; 2000: 411-416.
2. Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease. 8th ed. Philadelphia, Pa: Lea & Febriger; 1994: 588, 1033.
3 . Beyer PL. Medical Nutrition Therapy for Upper Gastrointestinal Tract Disorders. In: Mahan KL, Escott-Stump S, ed. Krause’s Food, Nutrition and Diet Therapy. 10th ed. Philadelphia: WB Saunders; 2000. p. 666- 694.