Manual of Clinical Nutrition

Manual of Clinical Nutrition Management B- 15 Copyright © 2013 Compass Group, Inc.

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 sugar, and is high in protein and moderate in fat. Fiber gradually
integrated into the meal plan may also be beneficial in delaying gastric emptying (1).

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 or alters secretion of GI hormones

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 30 minutes after a
meal (1). Some postgastrectomy patients experience “late dumping syndrome” characterized by hypoglycemia 1
to 3 hours after a meal. Late dumping syndrome results from rapid absorption of simple sugars in the small
bowel, which triggers an exaggerated release of insulin resulting in reactive hypoglycemia (1). Patients with late
dumping syndrome commonly complain of sweating, dizziness, tachycardia, irritability, hunger and syncopal
symptoms (1). Dumping syndrome symptoms are more prevalent in the immediate post-operative period and
frequently resolve overtime (2). Dumping syndrome unresponsive to diet manipulation may require use of gut-
slowing medication (2).

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 Section IA: 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” or “Postgastrectomy 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 (1,3,4)

1. 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 Section IC: Sugar in Moderation Diet.) Complex carbohydrates and gradual increase of
   high fiber may be included (3).


2. Taking liquids with meals is thought to hasten gastrointestinal transit. Drink liquids 30 to 60 minutes either
   before or after meals (3). Consume adequate amounts of liquid throughout the day in small amounts at a time
   (1,3,4). Carbonated beverages and milk are included based on individual tolerance.


3. 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.


4. Lactose, especially in milk or ice cream, may be poorly tolerated due to rapid transit time. Cheese and yogurt
   are often better tolerated. A Lactose-Controlled Diet may be beneficial if symptoms are related to a primary
   or secondary lactose deficiency. (See Section IH: Lactose-Controlled Diet.)


5. Include high proteins food sources with each meal. Increase fats as necessary to meet energy requirements.
   A higher protein intake and increased fat intake also delays gastric emptying.


6. Encouraging to eat slowly, chewing all foods thoroughly as well as sitting upright while eating may lessen
   symptoms (3).


7. If adequate caloric intake cannot be provided due to steatorrhea, use medium chain triglyceride products.