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Wow, thank you, I think this is truly what I need to hear. I am already looking into therapists because while Ive never had an ED, I think it's better to be proactive then reactive, and I actually found one who uses food as healing which I think will be great for me! I definitely am giving myself credit - I've lost 34 lbs from my first visit, and 10 post-op. I just am a "nip it in the bud" kinda gal when problems arise. Overall, I think aiming for perfection, as most of you said, right now is a good goal - but knowing it wont be perfect everytime is something I have to be mindful of!

I managed to lose my weight and keep it off, but about a year ago they diagnosed me with Reactive Hypoglycemia. I wear a monitor and eat very low carb. I recently spent the day in the ER due to being light headed and the only thing that showed up was my red blood counts were slightly low. Otherwise I feel pretty good, like the way I look (except some loose skin) Love wearing a size 4, but sometimes it is hard to find my size. Funny, that was an issue when I was in the 200's. Now I look at the larger sizes and wish they were in my size, lol. Picture of me on the right.

I also developed Reactive Hypoglycemia about a year ago (I probably had it longer, just didn't realize) I wear a Libre CGM and have discovered it reads a bit lower than my one touch meter. I have been following The Glucose Godess for tips on how to eat without creating a huge spike and a deep drop. I feel like so much food is out of my reach now as almost everything causes a spike. I see an endo for this issue and strive to keep my spikes under 150. I have heard this can be reversable, but not sure if this is true.

I've had reactive hypoglycemia for the last 4-5 years. Definitely talk to an endocrinologist. I got a prescription for the Libre 2 wearable device that allows me to monitor my sugar levels in real-time. The Libre will notify you when your blood sugar is dropping or spiking. You'll learn which foods trigger low blood sugar soon enough. For me, it's sushi and alcohol or any high-carb food.

The VSG is somewhat predisposed to reflux, meaning that a greater proportion of those with that surgery will have that problem than the general population. The sleeve reduces the volume of the stomach much more than its' acid producing potential, and sometimes the body doesn't fully adjust to that. The bypass in comparison is predisposed to dumping syndrome, reactive hypoglycemia, marginal ulcers and mineral deficiency disease, so there are trade offs with whatever route one chooses (and with doing nothing, given all of the obesity related diseases that we are trying to avoid!) This is not unusual when we change things in our body - surgery of any kind changes things and sometimes there are negative aspects, or risks of, along with the positives. Medications change our body chemistry to solve a problem, but sometimes there are side effects that are negatives. It is routine for patients to be given a PPI for a while after any WLS, or even on GI procedures - I was put on pantoprozole for a month after a minor cardiac procedure I had a few months ago simply because when the body is under stress (like form surgery) it tends to over produce acid. So, being on a PPI at this point is normal, and nothing to worry about.

Building on my comments above, if you got along well with your band - it seems like you did - but just had mechanical problems with it, then the sleeve is a good replacement as its' character is similar, being strictly restrictive, but without the foreign object problem potential of the bands. The bypass is a good procedure that has been done for over forty years as a WLS, based upon procedures that are about 140 years old developed for gastric cancer, so it is a well established and understood procedure, both the good and bad. There has been a continuing effort in the industry to develop better procedures (as there should be) and a number have come along, with some remaining and becoming established as viable alternatives (such as the BPD/DS and VSG) and others falling by the wayside, never getting traction (such as the mini-bypass,) and others where the jury is still out (the SIPS/SADI/Loop DS.) The BPD/DS generally works better, being stronger metabolically, but is also technically more challenging to perform, so few surgeons have adopted it; the VSG came out of the DS (the DS is based upon the sleeve, and adds malabsorption) and has established itself as being comparable to the bypass in average performance - overall weight loss and regain resistance - in a more straightforward procedure that has fewer long term compromises for the patient. GERD is the main potential bugaboo with the sleeve, which compares with the bypass's predisposition toward marginal ulcers, dumping and reactive hypoglycemia. The ulcer potential is what presents restrictions on some medications with the bypass, the biggest group being NSAIDs, but there may be others that one encounters in life that will also be off the table, or severely restricted, with a bypass. There is also the blind stomach and upper GI loop with the bypass, which makes those areas more difficult to monitor and evaluate through life (can't just stick an endoscope down there to take a look,) and there are an increasing number of endoscopic treatments for a variety of maladies available these days that would also be off the table. If one needs periodic monitoring in that region, for instance for a history of stomach polyps or family history of some cancers, the bypass becomes much less interesting. Another factor to consider is what I call the "Plan B" case - what to do if things don't work out as expected and things need to be revised? While the bypass is technically reversible, that is rarely done as that in itself is another fairly complicated procedure. The bypass, overall, is something of a dead end procedure in that it is difficult to revise into something else is need be. As weight regain is similarly possible with either the sleeve or the bypass, there isn't much to be done to correct that with the bypass - installing a band over the pouch or tightening up the stoma are the most common revisions, and neither has a very good track record for resolving regain problems. The VSG, on the other hand, can be revised (some would say "completed" into a DS fairly easily as it is the first step in a DS, or it can be revised into an RNY if GERD problems can't be resolved with meds (the RNY is usually reversed if an ulcer problem can't be resolved with meds. So, more options are available with the sleeve should a "plan B' be necessary. These are the reasons why the sleeve is building in popularity; there are good reasons to choose either, but one needs to take a close look at one's circumstances going into it to determine what is the best trade off for one's needs.

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.

Thanks for indulging my curiosity. To [hopefully] clarify the conversation, black are my original questions, red are your replies, purple my feedback. Just to ensure everyone is on the same page, Dumping Syndrome is typically related to consuming sugars and/or fats, as has been previously mentioned. Dumping on other foods is exceptionally unusual. How often do you dump? If it's responsible for the majority of your weight loss as you claim then you would be dumping pretty frequently. If it is actually dumping you wouldn't likely be dumping enough to impact weight loss. So I never said I was losing weight because of this. I think I lost weight just from keeping on the proper plan initially. I would say I get sick at almost every meal, regardless of the ingredients, but it's severe with anything carb or sugar-related. Sorry about my misunderstanding. I inadvertently connected two unrelated thoughts. I apologize. The fact you get sick at almost every meal would tell me you aren't generally dumping. It's not to say that you are never dumping, just that it is not generally what is going on. What actual foods cause you to dump? Pretty much everything but it's particularly horrible with carbs, sugar, and greasy/deep-fried foods. Again, "Pretty much everything" would indicate that much/most(?) of what you are experiencing is not dumping. Dumping is in response to specific foods rather than most foods. In what quantities? I don't measure anymore but it doesn't take much. A few bites will do it, or even a small square of something sugary. I understand that you don't measure, neither do I. "A few bites" does answer the question, though. A 1.5" x 1.5" square of fudge or comparable sugar dense candy can easily make me dump. How soon after you eat do your symptoms appear? Within 10-15 minutes. What are the symptoms? It feels like my heart is going to pound out of my chest, feel dizzy, head pressure, brain-fog, and overall sense of anxiety. I also get reactive-hypoglycemia...but not true hypoglycemia. My body just responds very poorly to blood sugar drops because they happen so fast, but rarely have I been in hypo numbers. These comments add I think what are the more important pieces of information. If this were dumping, you could simply reduce the sugars or fats that might be causing distress. But when it's almost everything, frequently, then it doesn't sound like just or even mostly dumping, if it's dumping at all. If you are, in fact, over consuming sugars and/or fats over frequently then your initial steps would be clear: stop doing that and see if this fixes your issue(s) in short order. If you've tried yet continue over consuming sugars and/or fats frequently and unable to stop yourself then were I in your shoes I'd get myself to a therapist post haste. [ETA: I have not gotten the impression you are out of control in this way. Quite the contrary.] This is not a diet or nutrition issue in my opinion. It's not that you're not working to eat the correct foods, it's that eating any foods too often cause physical distress. Were this me, I would have long ago become a squeaky wheel. I would be camping in my surgeon's or PCP's offices until I got a resolution, or at least significant progress, in fixing whatever is going on. I would not be put off. Bottom line: Get your medical team to work helping you. Be your own advocate. Good luck, Tek

Hi there, thanks for responding. Here are answers: How often do you dump? If it's responsible for the majority of your weight loss as you claim then you would be dumping pretty frequently. If it is actually dumping you wouldn't likely be dumping enough to impact weight loss. So I never said I was losing weight because of this. I think I lost weight just from keeping on the proper plan initially. I would say I get sick at almost every meal, regardless of the ingredients, but it's severe with anything carb or sugar-related. What actual foods cause you to dump? Pretty much everything but it's particularly horrible with carbs, sugar, and greasy/deep-fried foods. In what quantities? I don't measure anymore but it doesn't take much. A few bites will do it, or even a small square of something sugary. How soon after you eat do your symptoms appear? Within 10-15 minutes. What are the symptoms? It feels like my heart is going to pound out of my chest, feel dizzy, head pressure, brain-fog, and overall sense of anxiety. I also get reactive-hypoglycemia...but not true hypoglycemia. My body just responds very poorly to blood sugar drops because they happen so fast, but rarely have I been in hypo numbers.

I had the same symptoms as ms.sss. At 3 & 1/2 months on Thanksgiving, I tried Ben and Jerry’s lactose free ice cream. I had 1/4 cup and it hit me half an hour later, maybe less. I’m finding any sugar/carby food can trigger it, or sometimes it’s a reactive sugar drop a few hours later. Air popped light salt popcorn triggered it last time. I was never diabetic. I find dumping does keep me on the straight and narrow which is good! If you do want to try new foods, it helps to be at home with a time block of a few hours and a protein shake to counter the sugar lows. For those who think dumping is a get out of jail free card; there’s no weight loss. There may be a slight loss sometimes, but it’s water from the both ends pushing it all out. Mostly I find I still gain weight and trigger an asthma attack from all the inflammation. I have even measured my ankles and found them to be 2-3 centimeters bigger the day after a carb incident.

I know someone through a WLS support group who developed reactive hypoglycemia after surgery. I think the best bet is to check in with your doctor. Good luck!

Could really be a number of things for many of you here. I use an at home monitor and I was having low blood pressure 88/58 etc. .. For those who speculate orthostatic hypertension diagnosis can be confirmed with the tilt table test mentioned by a poster in this thread it could also be,for those with bypass, reactive hypoglycemia (occurs like 3 hours after eating something substantionally Carby) which u could use a cheap glucometer or borrow a friends during an episode to test if your blood sugar is low. For those who want a diagnosis after having low blood sugar it can be confirmed with lab test gtt (glucose tolerance test) extended 4 hours

Hi I enjoy your food pics in the other thread. I am glad you are approaching your doc about this. I will say sometimes pouch decides it doesn’t like a food all the sudden even if I’ve had it before then I just ban that food for awhile and try to reintroduce it later. I do recommend you to have a glucometer just the cheap one. I am one of the lucky ones who has non diabetic reactive hypoglycemia as a result of the rny. I would not have known if I didn’t check the sugar in a “nap desiring” state after consuming a little higher carb than my norm

wouldn't be dumping. "Normal" dumping happens pretty soon after you eat. What they call "late dumping" (also called reactive hypoglycemia) happens 1-2 hours after you eat, and can last a couple of hours. Sounds like you ate something that didn't agree with you - or else you've got a bug.

it may have to do with blood sugar. Starting about year 3, I started having occasional dizziness that I couldn't explain. Had a complete workup at the doctor's office. Nothing. Everything normal. The next time I noticed it, It was about two hours after I had a piece of cake. I mentioned it to my doctor - she thinks it was probably reactive hypoglycemia, which sometimes happens in RNY patients (not super common, but it does happen to some). She thought that my glucose level just happened to be normal at the time I had the workup, so it didn't jump out at them. She recommended I eat something every three hours - preferably a protein - but if I eat a carb, to be sure to at least pair it with a protein. That seemed to have done the trick. At least for me. That may not be going on with you, though - you might want to check with your doctor.

I went with the sleeve because, fundamentally it does the same thing as an RNY - amount of weight loss, regain resistance, etc., but "costs" less in terms of trade offs and potential problems. The sleeve is predisposed toward GERD problems (that simply means that more people in that population will suffer from that problem than in the genera; population. In contrast, the RNY is predisposed to marginal ulcers, dumping and reactive hypoglycemia.. It is also fussier in supplement need - you can get into more trouble if you are lazy about your supplements with an RNY, while a sleeve can be closer to that ideal of getting all of your nutrition from your food, if one is so inclined (and your natural body cooperates.) Even with all the supplements in line, there is still a greater risk of iron issues or osteoporosis with the RNY as its malabsorption is focused on minerals. And, the marginal ulcer risk makes it more limited with some medications (it is the origin of the "no NSAID" rule in bariatrics - the sleeve based procedures are more tolerant in that area. If I need something stronger than the VSG, then the DS is readily available, as it starts with a sleeve and adds a stronger malabsorbing component than the RNY offers, so there is better weight loss and most importantly, regain resistance provided there if needed. Finally, there is the "Plan B" factor of what if it doesn't work for me and I have/want to revise? The sleeve is readily revisable to either the RNY or the stronger DS, while the RNY is something of a dead end procedure which is very difficult to revise (it can be done, but there are few surgeons around who are qualified to do so.) Overall, that is why I would start with the VSG and move up later if needed (or if I was starting from a very high BMI or otherwise challenging metabolic situation, I would go straight to the DS and avoid the risk of having to revise the bypass if it wasn't strong enough.)

Sounds like everybody else recognizes it as reactive hypoglycemia. Be careful what you eat going forward.

I got that at about two years out. I went in for a work up (they checked EVERYTHING), and everything came back normal. Then I noticed it again about an hour or two after I'd eaten a piece of cake at a retirement party. I mentioned it to my PCP, and she said it was probably reactive hypoglycemia - my glucose may have just happened to be normal when they did the work up. But then you said your glucose was normal during or right after that event, so that's probably not it. I'd let your doctor know...

It could be reactive hypoglycemia, but you said you've checked your blood sugar. It could be a form of dumping (are you eating things that are higher in sugar or fat when this happens?), it could be that you are eating too fast. I would keep track of when this happens and see if you can identify what the common factors are. Also... definitely try to reach out to your doctor.

I had my op October 2021, Doing great, the weight loss is coming off. 5 and a half stone so far, I feel so much better and able to move more, I am happier thats for sure! However I do have a question......Just recently when I eat, straight after I get all hot, sweaty and shaky and have palpitations almost like a diabetic Hypo(low blood sugar) . However I checked my blood sugar, and it is normal. Am I eating too fast? I have no other symptoms. This is just weird!!! Love & Light

I’m 11.5 months post op and I have lost 175 lbs total since this process. Starting weight was 358, surgery day weight was 331, current weight 183! Prior to my surgery, I was terrible at logging food, exercising regularly, and had a terrible relationship with food (addiction, portion control, etc). Of course I knew what to do conceptually but the follow through was the issue. I told myself (and truly believe) that the surgery was not the fix! It’s just a tool! A tool that allows me to fix the broken things. What I’m getting at is, although logging food is “difficult”, it’s necessary! You have to be willing do do things differently and consistently if you want to reach your goals. Set up your environment to help you be more consistent: meal plan, log your planned foods the night before or first thing in the morning. Proactivity rather than reactivity is key! I treat my food log like I budget my finances, I track input and output and plan ahead! You got this! You just have to tell yourself you’ll do what it takes. The habits that got you in this situation won’t get you out of it! Embrace your second chance at becoming the best version of yourself and focus on the inputs and the desired outputs will happen! Don’t be afraid to consult your medical team and seek mental health help if need be. We all decided we can’t do it on our own which is why we took this journey. You owe it to yourself to be better than you think you can be! Good luck!

thank you both for the comments! nice to know people are reading my musings @Stella S thanks mama and congratulations on maintenance! @MiniGastricBypassDude thank you! i find it easy to maintain late 170s no problem i did for over a year. i actually would like to drop pounds and get to say 160 if i dont look too small. im about 5'8 and around 180 i look pretty normal. wearing a US 8 or UK 12 in jeans and US6/UK10 on tops. i often crave popcorn and i think thats to do with zinc. cookie dough currently because there is a chocolate orange version i saw and chocolate orange is my absolute favorite LOL. Yesterday i went running, and then just ran errands with my friend, i havent brought a new scale or been able to locate a battery so just really thinking about what i am eating and physical activity. im sure calories came in at about 1300, so i do need to watch it more. I have a friends birthday tonight and will be drinking. my day should look like 2 protein shakes, 2 cocktails, and small amounts of what i want to eat, im off to Hakkasan! i think from monday i will stop eating at 7pm, also want to reach out to my GP as i think i might be reactive hypoglycemic,

mine isn't chronic, but I was experiencing occasional reactive hypoglycemia (RH) when I got to be about two years out (it'd hit me about two hours or so after eating - not all the time, but enough that i knew something was going on and had a complete work-up). My PCP recommended eating something about every three hours - preferably a protein - and if I DID eat a carb, to be sure to pair it with a protein. Seems to have helped - I rarely have that issue anymore. btw - if yours is due to RH, that's not unheard of with bypass (not sure about the mini version of bypass, though...)

You look wonderful! Do you mind me asking if insurance paid for any of your plastic surgery? If not, how much did it cost? I am currently pre op (surgery date is 1/18/22) so I know I'm getting ahead of myself but I am 54 and anticipate lots of loose skin. Hopefully you are feeling better these days and have figured out your reactive hypoglycemia issues.

Exactly this! Now I literally eat what ever I want because I exercise a lot. Early on, my cravings were for protein, fruits, and veggies. I do not eat much in the way of concentrated sugars at this point, due to reactive hypoglycemia, (said as I munch on some teddy Graham’s). 🤦🏼‍♀️With that said, I am in maintenance, ran 4 miles today, and do not want to lose weight. In maintenance, you can eat foods you want to eat providing they do not make you physically ill or cause you to gain unwanted weight.