Effect of dietary fiber on complications of gastric surgery: prevention of postprandial hypoglycemia by pectin.

The dumping syndrome is a very troublesome problem to some patients after gastric surgery. Gel-forming carbohydrates have recently been used to modify glucose absorption. The addition of 14.5 g of pectin to a 50-g oral glucose load prevented the occurrence of hypoglycemic symptoms and maintained the blood glucose levels above control values by 64% at 90 min (P less than 0.002) and 46% at 120 min (P less than 0.01) in postgastric surgery patients whose 120-min values after 50 g of glucose alone had fallen below 50 mg per 100 ml (2.8 mmoles per liter). Breath H2 production, used as an index of bacterial fermentation of glucose, was abolished or reduced by pectin in all 5 cases in which this had previously occurred. A trial of 10 g of pectin per day prevented recurrent postprandial hypoglycemic attacks in the most severely affected individual. Pectin and perhaps other unabsorbable polysaccharides are likely to prove useful in the treatment of abnormal carbohydrate absorption after gastric surgery.