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Do anyone in the morning after waking up experience low blood sugar? I wake up fine, then try to have something to eat, then a few minutes later I feel warm, sweating, feel like passing out. I read something about reactive hypoglycaemia, and before I had the sleeve I had low blood sugar moments. Now I been sleeved for almost 3 months now and its happened 3 times to me since. What do you do, anyone experience it?

Thyroid meds can be tricky, especially when you don't take them consistently and properly. My thyroid was taken out due to having thyroid cancer. But I've always made sure to take my meds at the same time everyday, on an empty stomach, with nothing to eat for an hour afterwards. I lost 60 pounds prior to surgery following a less than 1200 calorie diet and exercising 4-5xs/week. So while being hypo is a challenge, losing weight is very much doable if you are disciplined and consistent.

Has anybody tried adding Fiber to their food/shakes? I am 5 weeks post op, approved for all foods, but dont really have room for high fiber foods after getting the Protein in. I would prefer a premptive approach rather than a reactive one as I am worried about treatments "kicking in" during inopertune times like meetings, driving etc. HW 385 SW 359 CW 335 (50lbs down!) Sleeved 10/5/16

Hey folks, I will be following here. I have had reactive hypoglycemia in my past, pancreatitis in 2015 and am the adult child of 2 diabetics, not diabetic yet another reason why I have an upcoming RnY b.s. instead letting my faulty sugar heredity catch up with me So this subject resonates with. me so hard even you can feel the vibration.

There is no universal carb limit prescribed by surgeons after WLS that I know of. My surgeon / NUT / bariatric PA never mentioned any carb limits at all. Just Protein limits. Therefore, I never, ever focused on low-carb during all my weight losing phases. Also, I read early on posts by the very small percentage of folks who developed post-bariatric reactive hypoglycemia. It seemed to me (just a theory here, no serious research about it done that I can find) that these posts were all made by people who'd gone significantly low-carb for most of their weight-losing phases. So I decided I didn't need to lose weight super-fast anyway and would just eat plenty of healthy, unprocessed carbs. And I did. Coincidentally, I wound up matching my protein and carb levels. Early on, my Proteins / carbs were around 60, with daily cals around 800. Then in Month Five I ramped up to 1000 cals, and proteins and carbs went up to 80. Then in Month Seven I ramped up to 1200 calories, and my proteins and carbs went up to around 100. I reached my weight goal (150 pounds) 8.3 months post-op. I've lost another 6 pounds since then (in the last 3+ months), but I think I'm now stabilized. By now, my daily maintenance calories range from 1300 - 2000, and my weekly averages are over 1600 cals. I think my final maintenance calorie budget will be 1700-1750. Honestly, looking back, I think I lucked out by not going super low-carb or super low-cal during my weight losing days. I have online friends who ate a lot less during the weight-losing phases, and some of them (not all) are struggling to maintain their goal weights at 1200 cals/day. And who knows what I'll deal with in the coming years as I work to maintain this weight. So that's been my experience. Take from it what you will. And realize that our bodies don't all respond the same to food. If we were all alike, this whole weight loss / weight maintenance business would be a helluva lot less mysterious.

A few random thoughts, in no particular order - You will likely lose some muscle mass as you lose weight irrespective which procedure you get; the main emphasis in general for WLS is to minimize muscle loss as we lose. Some maintain that it is impossible to build muscle mass while in a caloric deficit (needed to lose that fat) and while I never like to say "never" on such things, I would say that it would be exceptionally rare for it to happen, Typically, we lose what we need to lose to a healthy weight and body composition, and then work on building additional muscle mass if we so desire. The bypass and VSG have very similar weight loss and regain characteristics - there isn't much to choose between them from that aspect. You may lose a bit quicker with the bypass owing to its malabsorption, but will ultimately end up in the same place. The caloric malabsorption of the bypass is a temporary thing - it dissipates after a year or two - so weight maintenance is similar for both; nutritional malabsorption is a long term affair, however. As long as one stays on top of supplements and lab tests, both are good for long term health. The bypass, however, is somewhat fussier in its supplement requirements - minerals are malabsorbed, so one usually needs to supplement iron and calcium more than with a sleeve (and that may not be enough, as the need for iron infusions is usually greater with the bypass than with the sleeve. Iron and calcium is somewhat fussy as they need to be spaced out during the day. it's mostly a matter of establishing the habit, but this will bother some more than others. The sleeve has a predisposition toward GERD or acid reflux, so if one already suffers from this, the bypass is often preferred unless there is a specific identifiable cause that can be corrected during surgery (such as a hiatal hernia.) In contrast, the bypass is predisposed to dumping, reactive hypoglycemia, and marginal ulcers (which precludes the use of NSAIDs such as ibuprofin or aspirin, which are better tolerated by the sleeve.) The sleeve is conceptually a more straightforward, or simpler, procedure. However, it still takes some time and practice for a surgeon to master, so it is well to ensure that a prospective surgeon has performed several hundred of them. In the US, that isn't a big problem these days as most have been doing them for several years, but in other countries where they have been slower to adopt it, this may be a consideration. Owing to their national health policies, Canada is running about five years behind the US on their learning curve, and other countries seem to be similar. There is a recent poster (from AU, IIRC) here who went through a quick revision from an initial sleeve to a bypass within the first week or two, that is likely an example of this. So, if your surgeon is recommending one over the other, it is well to pay attention to them - their recommendation may (or may not) the absolute best thing for you, but it is likely to be the best that they can do for you, or are most comfortable performing on you.

Well not really. I drank muscle milk which had either 9 carbs or the 100 calorie version that had 4 carbs. So definitely no spikes from that. I did lower my basel on my insulin pump. It definitely helped taking less insulin, but still had a few hypos. Drank orange juice for that. It was definitely tough, but well worth it.

I changed my thyroid medicine and wanted it rechecked b4 heading down there next month. I also included some typical chemistry panels and liver enzymes, also c reactive protein. I'm a member of Life Extensions and you can order the lab from them and go to certain facilities and have it emailed to you in a few days. It cost me about 150, but worth not having to try to get copy of my lab from pcp. I'm anal about keeping my records in chronological order (ha- first born of course).

"This stall is why I always failed at diets in the past - when they inevitably occur, it's just so demoralizing!" The great thing about being sleeved is that a stall will not make you fail at this. Like you, in the past it was really easy to fall off the wagon when it seemed like good behavior wasn't doing any good anyway. But now I eat a certain amount and that's it, no more space. So it makes it a lot easier to ignore a stall, at least w/r/t engaging in negative reactive behavior. It seems like the stall question is the one that is most often asked, by far, by us newbies. I can't wait to get to the point where I look back (several stalls later) and realize how much energy I wasted worrying about them. Rick, that was a super well considered, well written post, thanks for sharing it with us.

Hi everyone. New to the forum. I had gastric bypass in 2010. It has been six and half years. I weighed 232 pounds prior to sx. Within 9 months I weighed 145 pounds and that is pretty much where I have stayed for the past six years. I wear a size 8. I weigh every day and when I hit 150 I cut back until I am at 145 again. I still "dump" almost weekly but not as severely or as easily as in the beginning. By "dump" I mean if I eat too much sugar I feel nauseous and need to lie down for awhile. No sweating, no beating heart, just want to throw up but can't. miserable. One year after sx at my check up my labs were normal except for K was low. I did not do any more follow ups until this summer. I called my bariatric surgeons office and explained I wanted to touch base. I just left my appointment. Oh...I have a confession. Four years ago I quit taking my mult-Vitamin and Calcium. I have been religious with my B12 and VitD however. My labs were all completely normal. I did confess my lapse of the multi and calcium to the doc; to my relief he told me since my labs were normal that essentially I am absorbing what I need from my food. He told me to keep doing what I am doing and I told him he probably would not see me again unless I encountered a problem. In addition to still dumping (which I am glad I do; but he said is patients usually do not dump so far out) I have an occasional episode of reactive hypo-glycemia. If I eat clean I can avoid both situations but I still have the head that got me fat in the first place, so there you have it. Just thought some might be interested in this info from someone a ways out from sx.

Lady in article sounds like extreme case. Reactive hypoglycemia is one of the forms of "dumping". More likely to happen with RNY but can happen in sleeve but not usually (I get it with sleeve if I eat too much sugary stuff but would never be so bad as to pass out. )

Many people who undergo bariatric surgery suffer from a type of hypoglycemia (low blood sugar) called Reactive Hypoglycemia. This article will explain the condition. https://www.ridgeviewmedical.org/services/bariatric-weight-loss/enewsletter-articles/reactive-hypoglycemia-postgastric-bypass/

Hair loss is common, however it's not exactly "hair loss" in the normally used sense. Your hair is thinning because surgery caused your body to trigger a "rest phase" on more hair follicles than would normally be at rest. When they reactivate, they shed the hair they were holding. This appears to be "hair loss" in reality it's just a larger percentage of the normal shed process happening at once due to the surgery. Good news is, the condition is seldom permanent and re-growth typically is complete. It's just going to take some time to get all that hair back to your preferred length. I'd avoid any cosmetic tattooing for at least 6 months to a year to allow your body to get back to normal. I'd hate to hear that you had the tattooing, then your hair grew back and it looks silly or funny now.

Hello John, Did I read right? Your surgery has been delayed by 2 weeks? I'm on the home run, surgery on Tuesday,11th July. As I'm diabetic I'm the 1st patient on the day,I resent the 7am show up, but then its better this way isn't it? I won't be stressing the whole day waiting for my time I've been given. Good luck with the diet they've given you as you have another 2 week wait. Incidentally,what are you consuming on your diet ? I suffer from diabetes and hypertension's,thats why I want gastric bypass surgery, i have 6 brothers,4 of them have had heart attacks, my father died from a heart attack thats why I want the op. Its a shame I'm vegetarian, easier way to get protein if you're a meat eater. Im feeling better then I was last Saturday when I started the preop diet. Last night wasn't good as I got a hypo. My diabetic meds will definitely have to change after the op. Yes I'm set for Tuesday,ive bought my M&S cotton dressing gown ;-)''.

I can't comment after surgery but I can after weight loss (which obviously I regained). I reached a weight I was happy at, not in the healthy weight range for BMI, but I was curvy and fitted a size 12 (Australian). Losing the weight gave me the confidence to put myself back out there, as it were. I put a profile on a dating site, had some contacts, didn't meet too many, but there was one who I was quite taken with...we were together for about nine years. That relationship finished up March last year. With the weight loss and improved self confidence, I was happy to wear fitted clothes in lovely colours not the baggy shapeless clothes in dark or dreary I tended to wear. I know there are plenty of people with the confidence to put themselves out there regardless of what they weigh, not me, I practically become a recluse. For the period of time I kept most of the weight off I was quite confident and social. I wish I had that confidence, that self believe in myself regardless of what a number on the scales say. I think confidence is an attractive trait and people respond to it in a positive way. With confidence we stand tall, we smile at strangers, most strangers (including service staff such as shop workers) reactive positively to people who smile, who don't slouch etc. And to be fair to the opposite sex, there are plenty of men who love a confident (or not) woman regardless of what she weighs. Sorry for waffle!

I had this earlier this year... http://www.mayoclinic.org/diseases-conditions/diabetes/expert-answers/reactive-hypoglycemia/faq-20057778 I was not eating meat, and it cause me a ton of issues. I changed how I was eating, back to my normal way of eating and it has stopped. The whole experience was pretty traumatic. Have you changed how you are eating lately?

I think you need to have a blood test to check your protein levels, vitamins, minerals, sugar, etc. Then you’ll know what your missing in your diet & your surgeon & dietician will be able to best advise you. And as @The Greater Fool said camp out at your surgeon & doctor’s & demand attention until you get answers & a way forward. I agree completely with @catwoman7’s advice around your caloric needs. We’re not all the same & there are too many factors that influence what you need as an individual. The blood test will help inform what your macros goals need to be - whether you need more, less or are consuming enough. I really appreciated the 3 monthly blood tests (& appointments) my surgeon & his colleague requested the last three years (just moved to 6months now). We picked up things like how removing my gall reduced my protein absorption, my vitamin D levels drop a little in winter, I didn’t need to continue to take multivitamins after I reached maintenance (except D in winter). I also agree with the advice to cut out any high fat or high sugar foods out of your diet & see if the dumping improves. Hypoglycaemic episodes gives me similar symptoms to what you’re experiencing though. (I usually eat a couple of berries as the little burst of sugar ease it very quickly.) Maybe your reactive hypoglycaemia needs to be explored further with your doctor too. All the best.

I have Reactive Arthritis and Osteoarthritis and take Azulfidine for it. I finally was able to get off prednisone Jan 25, 2008. I am getting banded April 23 and have been wondering if I can take the azulfidine without cutting or crushing it. (since it's enteric coated) Any thoughts?

Wow, Lisa......I'm so sorry about your heart issues. And that you had an attack during childbirth! You are already coming into this with some serious potential issues, so you do need to make sure that you're not jumping from the pot into the fire. Though there are no guarantees either way, there is something reactive going on in your body, so you need to be SUPER careful. And I agree, no, I do not think that ALL issues are weight related. Weight does put a strain on so many things and causes other health issues, but it's not EVERYthing. I've done so much research on this; pre-surgery and now looking at a revision. With the bypass, the biggest (common) food issue is sugar. If you have a sweet tooth and eat a lot of it, you might get very sick (dumping). My next door neighbor had a bypass many years ago, and though she tolerates just about everything, certain things are hard for her to eat.......like popcorn. I guess everyone has to find their own balance once the surgery is done and we're back on regular food. As for the sleeve, if reflux is or has even been an issue, the sleeve isn't a good option. Reflux gets worse, and even those who never had it, get it. For me, there isn't enough long term data on that procedure, and I'm always afraid of the possible leakage from the staples. Though it doesn't happen often, if it does, you can be in the hospital for several weeks/months. I'm self employed, so that would pretty much put me right out of business. Since the bypass has been the gold standard for many years, I guess I'm just more comfortable with it. I've also heard that revisions don't lose weight as quickly/easily as "surgical virgins". I've heard this with both the bypass and sleeve. People lose, but it's a different experience over first timers. I think for you, given what you've said about your history, it might be a good idea for you to see your cardiologist to discuss. The heart issue is concerning and I'd want his/her take on putting your body through another bariatric surgery. This is serious stuff! But with that aside, you have to ask yourself the questions we always have to ask..... Will your weight continue to climb if you don't have surgical intervention? Though weight isn't the beginning and end all, I can tell you......as you get older, the health issues increase. From my 30 pound weight gain, I'm back on blood pressure meds. I had knee surgery in March and my knees are still painful. Ultimately, I will have knee replacement, but that is something I won't do unless my weight is down. The artificial joints have about a 15 year life, but with extra weight, even less. If I keep gaining weight, I'll probably end up with pre-diabetes/diabetes. When I was younger, all I cared about was how I looked. Now, it's all about the way I feel and staying healthy. No, I'm not thrilled seeing the extra weight come back on, but feel worse physically and have other health issues that are exacerbated by the extra stress on my body. You question about possible rejection to the sleeve is a good question. Honestly, because once the stomach is gone, what then? The bypass can be reversed, though I don't think it's as simple as removing a band. My doctor said he does about 4 reversals a year. He also said that band revisions are now about 20% of his practice. He rarely places them anymore; it's old technology. He seems to prefer the bypass over anything else. I will think of other questions, too. My doctor told me that I worry too much about things I don't need to worry about. Easy for him to say! Surgeons.....nothing is a big deal to them. But it is to me/us

This is common even for those who were not diabetic prior to surgery. It is called Reactive Hypoglycemia. Here is a link. https://www.ridgeviewmedical.org/services/bariatric-weight-loss/enewsletter-articles/reactive-hypoglycemia-postgastric-bypass

So my nutritionist cleared me for surgery and I was told I would see the surgeon within 2 weeks to schedule my surgery which was super exciting. Today I got a call from my surgeon and they told me that since my most recent blood work showed that i was hypothyroid i could not proceed with seeing the surgeon. I had seen my pcp and he told me that sometimes thyroids just mess up (mines has done this more than once) and seemed not to think it was a big deal. he told me to get my blood work done again and if i was still hypo he would put me on meds but did not schedule another appointment until september, so i didnt think it was that big a deal. He also wrote on my referral to my surgeon that although my thyroid is acting up right now, since i have been fat since i was 7, he was pretty sure that wasnt the reason for my obesity. my surgeon said it doesnt matter, insurance wont approve me with an unaddressed thyroid issue. I went back to the lab today, but I am super scared of what will happen if i am still hypothyroid, i dont think that i will be able to proceed any further even though im so close to the finish line.

I have too. ( Reactive Hypoglycemia ) But it was after the sleeve. And only a few months ago! I eat 6 times a day and very little refined sugar. I eat complex Protein. That means a carb with a protein and it seems to be working better for me......

I agree. Start as if you had surgery yesterday with the liquid diet and follow the 5 day pouch reset. That will help get a lot of the sugar toxins out of your system and it will jump start you. Then, focus on the rules: 1. No drinking anything 30 minutes before and 30 minutes after you eat. 2. Limit your beverage calories. Try to stay on Water or sugar free non carbonated beverages. Stay away from alcohol. If you can, even limit caffeine as it really does cause you to feel hunger. 3. Mindful eating, remove distractions so you can pay attention to your pouch. Your tool is still there, you just need to retrain it. 4. Eat your meals slowly chewing well in between eat bite. Put the fork down in between but do not go over 30 minutes for your meal as your pouch begins emptying at that point. 5. Drink a minimum of 64oz of water or SF non carbonated liquids. 6. Ensure you get a minimum of 1 gram of Protein for every inch you are tall. Even a little more is better. Make sure that you get that protein mostly from dense Proteins like fish, seafood, beef, chicken and pork. These foods will keep your pouch fuller longer and provide you with much needed protein grams. 7. If you have not done this recently, you should have a full Bariatric blood panel drawn to ensure you are not lacking any nutritional elements that could cause you problems. 8. Are you still taking lifelong Vitamins like B12, Calcium Citrate or any other vitamins your Bariatric Doctor put you on? If not, you will want that nutritional panel to inform those decisions. 9. No grazing.....this is where most people start to have weight gain. Eat your 3 meals a day and try to avoid snacking. If you are one of those people like me who has reactive hypoglycemia, then have 5 smaller meals. 10. Avoid sugar, potatoes, Pasta, rice and bread. Same thing with any prepackaged processed foods. Get rid of the junk and stick to good quality proteins and veggies and fruits. Once you hit goal again, then you can introduce some whole grains back into your diet slowly until you get to a good maintenance schedule. 11. Try to get some exercise even if it is just walking daily. These are the things that I will do if I ever start to regain my weight. It really is getting back to the basics.

Hello, I am from OR and had a vsg in Mexico as a self-pay patient in May 2014. I am still doing very well. The sleeve still prevents me from overeating and magically controls hunger as well as limits my sweet intake (i get reactive low blood sugar when I eat anything too sweet now and it is bad enough to avoid most times). I do not regret my surgery and in fact wish I had done it sooner. I run now, can do yoga poses easily and am enjoying the freedom of life-long portion control. I am still 12 pounds from my original goal, mainly because I stopped low-carb dieting and can eat more than when I first had surgery, but I love my figure and my energy level and am taking my time reaching my goal. I wear between size 4-6 dress/tops/pants and may just maintain here as I feel really good. Research the right doctor for you. I am sorry to say the brilliant surgeon I went to tragically died in a plane crash about a month after I left his hospital. His team was fantastic, so I imagine they are still working and operating at Almater Hospital. Check into them. There was another surgeon I considered in Texas, named Dr. Guillermo Alvarez, I only ended up going with the one I did based on timing. Be prepared to pay at least $12,000 for the procedure, stay and aftercare, but it is worth it. It's still more reasonable than self-pay in the US. I would make sure you are in a clean hospital NOT A CLINIC for the procedure and that there is an actual medical team and nurses there for aftercare. I had mandatory counseling before the surgery in Mexico, which was important for maintaining, I had solid pre-op tests run as well as solid post-op tests. My only complaint was my doctor refused to give opiates so my pain was not well managed and I ended up in the ER when I got home for pain control. The US ER docs were shocked that a doctor in Mexico didn't provide pain meds. I was shocked as well. So, be sure to have someone with you to advocate for pain management. Other than that, I healed quickly and now it is a distant memory. Good luck, you will do well, just be prepared to pay over $10K for a good surgeon, do your research, reach out to people who used the surgeon you are selecting and make sure it is in a clean hospital. There are no short cuts or dollar savings worth your health and life.

Attached is a link to the condition that you are experiencing. It is very technical. http://spectrum.diabetesjournals.org/content/25/4/217 Here is another article but much less technical. It also has a good discussion on treatment and prevention. https://www.ridgeviewmedical.org/services/bariatric-weight-loss/enewsletter-articles/reactive-hypoglycemia-postgastric-bypass/