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I relied so heavily on this forum and others in the months leading up to my procedure that I promised myself I would provide a 12 month update, FAQ and experience summary for others planning the same thing for the same reasons. I recently posted this to Reddit and bariatricpal rounds out the plan. My story is positive – overwhelmingly positive – but I think most importantly my story is not emotional. I don’t have a psychological problem with food. I was never tormented or made to suffer for my weight (beyond finding flights uncomfortable and shirts being too short). I made this choice on statistical grounds – it would extend my life on average and go a long way to improving my diabetes. I wanted to provide a vanilla story to remind everyone this pretty survivable and the majority of people have non-descript and unexciting recoveries. My lift is pretty much the same - I just eat a lot less, dont shoot insulin and hopefully will live longer. Forums tend to have an over representation of negative outcomes - that makes perfect sense and it's absolutely fine for people to use them to get some reassurance and communicate with people in the same situation. For everyone else - just remember you're less likely to jump on a forum and tell your story if nothing went wrong or it wasn't any different from other people and as a result it can seem like a higher proportion of people are suffering than maybe is the case. I was a lower-BMI diabetic, not quite type 1 or type 2, but insulin dependent nonetheless. My BMI was 31, my surgeryweight was 126kg (277lbs) and I’m 196cm tall (6’5). I was diagnosed at 100kg (220lbs) but assumed type 1 as I wasn’t visually overweight. However in the 5 years since diagnosis I’ve continued to produce some insulin suggesting I’m not a pure type 1 or 2 - but closer to type 2. I gained 26kg in a year after diagnosis once i started on insulin. I’m broad shouldered/chesty with skinny legs - like an apple jammed on some chopsticks. Maybe like the fat Mr Incredible. My intention for having the bypass was not solely weight loss – I suspected that my diabetes was closer to type 2. I suspected the improvements people see immediately in diabetes management post bypass may apply to me. It was a gamble that paid off, My decision making process was quite straight forward – I had a young daughter at the time (now have a son too) and had lost my father to a heart attack when I was 7. He was fit and not diabetic but had a heart condition. I new statistically I was due for a similar fate carrying excess weight plus diabetes onboard. This was the best way to knock out one of those (the weight side) and hopefully improve the diabetes. I went from 126kg to 83kg (180lb), my BMI is low end of healthy. My biggest positive is my immediate cessation of insulin shots and a current HBA1c of 5.8 with oral meds only. It took about 6 months to get to my goal weight of 90kg. I'm still slowly losing and need to stop. Lead-up and Prep I was not obese to look at visually. The majority of healthcare professionals I spoke to did not think surgery, let alone Gastric Bypass, was necessary. In the end – my PCP, endo and surgeon all agreed that, while not essential, bypass was a prudent decision with potentially long-term benefits. The surgeon did not want me to bother with a gastric sleeve – if the endgame was diabetes improvement then the gold standard was a bypass. In Australia you need to be over 35 BMI or over 30 with a comorbidity to be eligible. I had slightly elevated Blood Pressure - that plus the diabetes made me eligible. I paid $2000 out of pocket, my private health insurance paid the rest. No psych required, I had a few meetings with a nutritionist and everything was greenlit. From first enquiry to surgery was four months. The fee I paid includes lifetime consults with the surgeon. I did not need a pre-op diet as i was not that overweight and my liver was not a concern. Surgery My procedure was in June 2018. My anaesthetic recovery was rough, but otherwise the process was fine. The most discomfort was immediately in the 12 hours following – in part due to surgical site pain but mostly because the bed could not accommodate my height so I was forever crossing my legs or scrunching them up, only to have a nurse slap them and wake me up for fear of DVT. Nurses kept promising to find a bed extender - eventually I lashed out in a post-anaesthetic haze at a nurse who slapped my feet - she took the end off the bed with a flourish. My feet shot out, I cried in relief, apologised profusely and slept for eight hours. Day two was stiff and sore but i was mobile, able to shower and sipping fine. I went home the morning of day three. I had PHENOMENAL life ruining headaches from day two. I went home with some serious opiates because I lived 90 minuts from my surgeon and couldn’t drive to get a script if they hit again. On day four my dietician cleared me for coffee and it immediately wiped out the headache – turns out I’d been in caffeine withdrawal. So I really recommend you taper that off in advance if you have a problem with coffee like i do. If you're diabetic then buy a freestyle libre glucose monitor for the procedure if you dont have a CGM. They want hourly blood glucoses, instead of being woken and pin pricked every hour I could just show them how to use the scanner and they'd take it while i slept. I had some minor aches 6 weeks out and one of the surgery sites oozed a little clear fluid. It subsided immediately. I was home for two weeks. I could have gone back at one week. I'm an accountant though and my starting weight was comparatively low so i was mobile quick. I completely understand if you're starting form a heavier weight then you should plan to take the full time. Food/Eating The normal progression of foods was fine and unremarkable from what is described on most forms. I graduated to solids a little earlier than I should have. I cheated like mad and was feeling fine, it was only when I snuck a tiny piece of casserole beef and vomited violently did I start to behave myself. I was vomiting once or twice a week from eating too much or too fast. Savoury ricotta bake, hearty soups and coconut water were my saviors. The vomiting subsided, 18 months out I vomit maybe once every two or three months and only when I do something stupid. My problem before surgery was eating very fast and taking large bites – that has been hard to deal with post surgery. In fact I tend to still eat large bites and then sit unable to eat for extended periods. I was very sensitive to sugar post-op and frequently had dumping. That subsided in a month with changes in eating, changes in my appetite and better food/liquid rules. I currently only get dumping in the morning, and only if I eat something sugary. I do get nauseous easily in the morning too – it’s something I’m working with my nutritionist on to find out why. Otherwise I can eat whatever I want within reason. I don’t drink soda, but had quit it before my procedure. Milky protein makes me nauseous too (any type of creamy protein really) so I use a water protein additive from costpricesupplements. This helps me hit 2L fluids daily. I can eat about a cup and a half food. Liquidy foods – stews, soups, casseroles – I can eat a lot more than that. Tougher foods like steak or dry chicken much less. I gulp liquids. I had a sensitive stomach before the surgery and took Metamucil religiously to keep my gut regular. I have not had any issues post op with flatulence but have had looser bowels. Metamucil still helps – but no worse or in any way less manageable than pre-op. Diabetes I went off insulin immediately after my surgery. It wasn’t a cure – I’m still diabetic – but metformin and trajenta keep me in an aggressively managed hba1c. I have a so-so diet – I eat too much sugary junk food and carbs. I could go without diabetic meds I believe but my diet would be depressing so ive truck a compromise. On this basis alone this was the best decision I could have made for my physical wellbeing. My blood pressure is fine, my cholesterol is non-existent and I'm able to even job a moderate distance without discomfort. Random observations • I’m cold. So cold. It’s 35 degree outside where I am (90’s Fahrenheit) but as soon as I go into any office I need a sweater. I really became dependant on sweaters, long johns and socks this last winter. Im not cooler in summer – just as hot and bothered as before. Maybe a better way to describe it is that I feel the temperature more in general, like I lost my insulation. • I am too skinny. Clothes don’t fit that great – most men this tall have a bit more chest/gut on them. Australia has limited/no tall clothing ranges domestically so I’m importing loads of stuff from the UK/USA. i still think i look fat when i look in the mirror. • My bum is bony and I need cushions to sit comfortably. I also had a cyst on a butt cheek I didn’t know about – now im so bony there I’ll need to get it removed so I can sit on kitchen chairs comfortably again. • I gained about 1.5” of penis length. It was a welcome addition. I needed to learn how to be more gentle and patient using it. With a young family and little sleep it's yet to be fully road tested – but I’ll be ready when we start to sleep again. • I have a little loose skin. nothing dramatic. mostly around the gut and love handles. • I am very sensitive to meds and drugs. I'm not much of a drinker but i like weed edibles - what would give me a mild buzz before gets me quite high now. I sober up quicker now too. I take xanax on flights to help sleep - i take a quarter of the dose now. • I drink red wine socially and now cannot really get drunk. I sober up quite fast but get a mild buzz pretty quickly too. • Dumping sucks but it should not be a discouraging factor. Its not life ruining – anyone who’s had a hypo as a diabetic it’s a bit like that with some gastro thrown in. It resolves pretty fast (30ish minutes for me) and is a self-reinforcing feedback loop for shitty food behaviours. For this reason alone I consider the bypass as the better choice for me. • I’ve lost a fair bit of muscle tone and will need to somehow up my protein and start some weight training to recover it. This needs to be balanced with not losing for further weight. • I have to remind myself to eat. Not just because of low appetite, but because once my pouch shrinks for a day then eating again can be uncomfortable and time consuming. As long as I eat fairly frequently my pouch is all good and I can eat quite a lot pretty fast – forget about it for 2 or 4 hours and I’ll need to take some time to eat a bit and get my appetite back. • I was hungry for 33 years and bordered on a pathological inability to waste food. I ate my meal and anything my wife or kid didn’t eat. I’d eat a meal out, go home and have a sandwich. We ate at bars and pubs because the servings were larger. I would eat until I was very uncomfortable if the portion was large enough. Now I still can’t bring myself to leave food – so I have this silly aversion to ordering anything more than something off the appetisers list. I don’t like asking for to-go containers (it’s an Australian thing – it’s really stupid because we pay so much for food out we should keep every bloody morsel) but have started to now order what I actually want instead of what I think I can finish. It’s funny – I went from ordering what I thought would be the biggest portion so I didn’t feel hungry (instead of what I thought looked good) to ordering what I thought I could finish and not waste. Regrets? None to speak of specifically. In a very minor way travel is less fun. I looooove travelling to southeast asia and the USA and love eating all the different things. My appetite is so low now, and eating can be so inconvenient, that I don’t get to eat anywhere near as much variety when I travel. I was recently in SE Asia and looking forward to a huge array of currys. I ate only two in five days as I had no appetite at all. I just need to travel differently now - actually plan to stop for meals instead of just charging all over a city and snacking on the way. I wish id been more sensitive to my wife's emotional processing of the scenario. She's gone from having the tall, chubby guy that was the physical build she was attracted to, to having a skinny beanpole. This was while she was having our second kid and all the very natural weight gain associated. She's not overweight and is, objectively i reckon, absolutely gorgeous but definitely feels marginalised by the process and is quick to colour me as vain or obsessed with my image now I am buying new clothes. I think i could have been more mindful of what I said or did. She was overwhelmingly supportive though and agrees this was worthwhile. Closing thoughts If you are considering this process and maybe you're on the margins of eligibility my experience would say go for it. my hope here was to give a vanilla experience to the mix, unique only in my taking the more permanent bypass on despite my lower starting weight. Sent from my SM-A705YN using BariatricPal mobile app

I have this same experience. It feels like "dumping", but truly is reactive hypoglycemia or low blood sugar. When you experience this or can feel it coming, eat something with 15 grams of carbs and the symptoms will subside in a couple minutes. Then follow up with some protein.

PS: My cooked cereal contains teff, amaranth, quinoa, and slivered almonds, along with soy milk, so the oat carbs are getting somewhat balanced by higher protein grains, nuts, and soy. I would never try something like plain cream of rice. I used to have very bad reactive hypoglycemia to plain carbs in my former life, so I learned to never take carbs without protein. I shudder to think of the reaction I could have now after bypass.

My nutritionist said the same amount (actually she said 1300!!) and then I told my DR and he said NO WAY THAT WRONG. So Id go by the Dr over ab nutritionist. He said that for the next six months should stay between 500-700 and if I find I am exercising A LOT then maybe 800-900 max so I think your calories are way too high. My surgery was 9/4 and Im at around 600 average but some days Im in the 400s others im in closer to 700 and i am working out about 4 days a week. I am hypo as well so I think we just lose slower because of that but I dont even know how i Could get in 1200 a day unless i ate all day long. My Dr said 1200/day Once i reach maintenance.

I'm hypo and have now lost about 155-ish pounds in round numbers from my recent high weight. I'm also on a drug called Femara that causes you to gain weight and am very insulin resistant with PCOS. It's tough. I had to obsessively watch what I put in my mouth, keeping things very clean, low carb and low fat. I kept my cals between 600-800 to lose (closer to the 600 end). I still have to be around 650 or so to lose. I maintain in the 900-1200 calorie range. At 7 weeks I was eating around 400-500 calories and 6 mini meals per day of less than 100cals each. Averaging 75g of protein per day as my goal.

You will find your balance with all of this. It’s a strange thing to experience for yourself, Right? I can relate to many of the post on how it messes with you when you hit goal. It took time for my mind to catch up and to see myself correctly.(body dysmorphia) It was something I had to work on. Wow. I get it. I would never in my life expect to say the words I need to STOP losing weight. My inner obese woman. *smile* had a hard time wrapping my head around it. People mean well, but comments like you look sick, your too thin, when are you going to stop losing weight. it's not helpful. It's hard enough for you to deal with rapid weight loss. Some of us have reactive hypoglycemia as a slight complication after surgery. Talk with your Dr and get a glucose meter. https://www.bariatricpal.com/search/?q=reactive hypo

yes. I'm hypo. I've lost 157lbs from my recent high of 287lbs. I'm in normal BMI and weight range and am my final Goal #3.

This has me somewhat baffled - and same as catwoman, I've never heard of this being done as a normal pre-op test. I would be interested in hearing what their rationale is, as my understanding of it all is that stomach emptying in a normal person is largely a function of the pyloric valve, which is being bypassed along with the remnant stomach in your RNY. I can understand that if you were having a sleeve or DS done, which preserves the pyloric valve, then faster than normal emptying could imply a higher risk of post-op dumping or reactive hypoglycemia, which are rare with the sleeve based procedures but relatively common with the bypass (owing to the existence or non-existence of that pyloric valve.) Maybe a tendency toward rapid empyting implies that the surgeon should give you a tighter stoma to slow things down post-op? Call me confused - but curious!

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.

They discovered I have 1 biggish nodule in the left lobe and multiple littler in the right, still at the "Watchfully Waiting" stage, Lefty is just a little under operation level, haven't gone Hyper yet, but I am still losing,weight , so I'm not that much Hypo either, although more. there than "normal" , but then most facets ofv me didn't fit that description so Why would,i expect my Thyroid to be Any different?

My original doctor told me I was going from hypo to hyper. At the time I felt no effects. Now it feels like I am on speed. Jittery and heart racing. Doctor went on maternity leave and unfortunately new doc only checked TSH and not T3 and T4. My sister is a pharmacist. She said she sees this all the time and by what I described she said definitely a thyroid issue. A TSH test is only as good as what is happening at that particular day and time. When I got off thyroid no problem. Then got back on half a pill a day and now having problems. So I am now oversensitive to it. Benadryl has no effect on me. When I take 4 benadryl melatonin and 2 Tramadol and still can't sleep then we have a problem. I don't do intermittent fasting. My body goes into overtime at night. Anyway, going to just get off of the thyroid for a month. Instead of going through Endocrinologist I will have my PCP reorder the tests but this time with T3 and T4.

As with most overweight people I suffered from hypo thyroid. However I am now at 205 lbs instead of 343 lbs and my hypo thyroid is now hyper. I got off the synthroid for a week. I wasn't sleeping at all and quite jittery. So then cut the tablets in half. Here I am tonight again and feel like I am on speed because everything is racing. Anyone else experience this? Driving me crazy.

I looked up dumping syndrome two weeks ago and reactive hypoglycemia came up there are I believe two tests I’m going to ask for them thank you Catwoman 🙂

I got that way when I was about three years out. I had a complete workup - nothing. Everything normal. Then I noticed once that I got a bad case of it about an hour after I ate a piece of cake at a retirement party. I asked my PCP if it could be RH (reactive hypoglycemia). She said it was definitely possible - it could be that my blood sugar was normal the day/time they tested it, so that wouldn't have jumped out at them. She said I could get a glucose monitor to verify - OR just try to eat something every 3-4 hours. Either a protein or, if a carb, then pair it with a protein. That seems to have done the trick - at least for me. The dehydration theory could also be what's up, though. (btw - during the workup they also checked my inner ear and checked me for orthostatic hypotension. They also did a urinalysis - not sure what they were looking for there - and did a complete blood panel.

Did you go thru a lot more corsets because of it? And I finally got my heart rate somewhat under control so I started working out and plan on getting my gym membership reactivated also ❤️

OK this is a new symptom that has started over the last couple of weeks. For those that have had reactive hypoglycaemia you know that slightly jittery feeling you start to get that tells you it's on its way? Well I've been getting that on and off lately but it doesn't become hypoglycaemia and my blood glucose levels are fine (eg. 4.8 mmol / 86.4 mg). It's not affecting me dramatically, it's just more annoying than anything. I haven't changed what I eat. I am exercising more but it doesn't seem linked to exercise that I do. Like, I could wake up feeling this way. I'm not drinking lots of caffeine. So what gives? Anyone else have this happen?

Dumping is different and involves your blood sugar going very low which causes nausea, sweating, throwups, shakes, fast heart rate. (It's usually a result for some people who have too many carbs/sugar at one time or who might have too much fat.) It can also result in big D. You're talking about foamies/throwups from not chewing your food, eating too fast, or eating the wrong thing that your tum doesn't like. It actually gets stuck in your pouch. It may also cause a RH (reactive hypoglycemia) attack which would lead to the dumping phenomenon...but only cuz it's stuck in your tool and your body released insulin on what it "thought" you were about to send down the pipes that didn't end up showing up.

Definitely regular icecream and not much of it on an empty stomach. I stole about 3 or 4 spoons of my hubby's Ben & Jerry's at the movies once and about 20 mains later I got the shakes, feeling faint, nauseous etc. Haven't tried more than one teeny spoon of ice cream since. I once had a petrol station machine mocha and a small can of Pringles and oh my that made me dump AND throw up with 20 or 30 mins. That was about 4 mths after surgery, haven't done that again. Those experiences were enough to make me very cautious about sugar. Nowadays 10 mths out from surgery I have had a few reactive hypoglycaemia attacks when I ate stuff I shouldn't have. A scone with a teeny bit of jam and some nice cream gave me a hypo two hours later. As did a whole packet of cheezles I stupidly ate in one sitting. Also if I eat sweet (white or milk) chocolate I have to be very careful or I'm hypoing two hours later. Basically if I break the rules, I suffer, which is what I (well, technically the Health Service) paid €7450 for!

Are you lactose intolerant? It honestly sounds like dumping to me. I had it just last night cuz I chose to have a crappy dinner instead of my planned dinner. Sucked. It sounds exactly like reactive hypoglycemia and some of the sugar alcohols cause this same reaction in bari-patients.

@freetobeallofme, I would love to stay in touch of your progress with your revision to RnY. I don't know why I'm so nervous now. Maybe, the closer I get to the 9/19 revision date then the more I find more frighten possible complications that goes hand to hand with the gastric bypass. My gerd is mild, per my latest upper GI. The pantoprazole 40 mg is suppressing my acid reflux for now. I'm still experiencing some mucus buildup in my throat and lump like feeling if I eat more than 4 oz of food or eating too fast. 4oz seems to be my sweet spot for comfort level and no gerd like symptoms. I use to be under the believe if I reach the 24 bmi; then my gerd goes away. However, I see some fit people posted on YouTube or othe wls boards still experiencing gerd. I have to lose 25 more pounds to be at a 24 bmi. I'm blame myself for worrying about possible side effects of the gastric bypass. The dumping and reactive hypoglycemia. I worry too much about things that have not happened yet. Up until June of this year, my gerd was not as pronounced. Not until an asthma/allergy attack put my acid reflux to being extremely bad while taking omeprazole. My doctor switched me pantoprazole and that medicine has controlled the daily acid reflux for now. On top of all of this, I will be making a major relocation to Europe, moving to the county Netherlands. So I'm worrying about would the Dutch doctors know how to handle my new medical case if I should still proceed with the bypass. My aunt had a revision from VSG to gastric bypass last year. She has no problems. She's happy. My aunt is super positive and do not let life worry her. I not at that level yet. I still have time to decide if I need to continue with the revision. I pray that I have a sense of peace about this decision. Thank you all for sharing your experiences with me and offering your kindness.

I wasn't given a permanent 'no' list but anything with quickly absorbing sugar is a big no-no. Icrecream makes me dump so fast my head spins. Same with commercial hot-chocolate/mochas. Jams and refined carbs give me reactive hypos and I HATE them with a passion so I just avoid those permanently now. But I'm lucky I can do a bit of dark chocolate without too many problems, so that's my bit of naughtiness.

I have to be pretty careful what I do eat before not-eating for a while/fasting. Anything that spikes my insulin response (that can include too much protein or something with hidden sugar like carby bread) and I'm guaranteed reactive hypoglycaemia three hours later. I hate it! But if I'm good, I'm fine. I'm doing 18:6 fasting no probs if I make sensible choices and I'm so attune to hypos I can sense when they are coming pretty early on and then I pop a glucose tablet or take a teaspoon of maple syrup. I've got it down to a fine art because I HATE hypos (T2 diabetic in remission here).

Dang girl!! ((hugs)) And saying prayers! It sounds like 1 of 2 things: Orthostatic hypotension (low bp) and dehydration can make this worse. OR Reactive hypoglycemia (but usually when I'm low enough to black out, I'm in a hot sweat, burning up inside, trembling uncontrollably, shaking hands, and needing to pee like a racehorse and very very confused, like I almost can't form a coherent sentence to let Mr. F. know I need help.) Do you have a bp cuff along with your finger stick? It's easy to tell OH because your bp will change very dramatically from one taken when laying flat and then quickly sitting up and taking it. It's a big sudden change in your numbers, it will drop lower with sitting than when laying flat. And RH is very easy to spot. Basically if you are less than 60, you need something to eat. If you are less than 40, you need to act very quickly with fruit juice or glucose tablets and take your bg every 15 minutes until you see it start to move up. Then 30 minutes to an hour later follow it with protein (I use nut butter I keep in single servings by the bed and a 6oz can of OJ by the bed -- also have glucose tablets and my bg monitor). Hope that helps! And you need to call your PCP and get seen!!! ((hugs))

Most any surgery that you can contemplate, in addition to the basic risks associated with surgery, hospitals and anesthesia, will have some risk of side effects that may be less than desirable, however we take those risks in order to correct a problem that we have created by injury, disease or genetics, with the intent that the result will be much better than what we started with. The various bariatric procedures have different predispositions to consider - conditions that happen more commonly than in the general population. The VSG is predisposed to GERD as the stomach volume is reduced much more than its' acid producing potential, and while usually the body adjusts and corrects the problem, sometimes it doesn't completely. Similarly, the RNY is predisposed to marginal ulcers (typically around the anastomosis) because the part of intestine to which the stomach pouch is attached is not resistant to the stomach acid like the duodenum is (the part of intestine immediately below the stomach outlet, which is bypassed along with the remnant stomach.) Likewise, it is also predisposed to dumping and reactive hypoglycemia owing to more rapid stomach emptying due to the lack of pyloric valve. Usually, these problems don't hit most patients, or don't persist if they do, but sometimes they are long term problems. These are things to consider ahead of time, particularly if one has any relevant pre-existing condition. Another consideration is that the VSG is fairly easy to revise if it does run into a problem that can't be resolved otherwise, while the RNY is difficult to revise or reverse. Another point to consider is that while the sleeve leaves behind a relatively "normal" anatomy, the bypass leaves a blind stomach and upper intestine which is more difficult to examine endoscopically, so some problems may not be diagnosed until they are more advanced and symptomatic. For instance, if one is subject to stomach polyps, that is a pre-cancerous condition that should be monitored, but is difficult to do after a bypass. An pre-op endoscopy is a good idea to understand what is happening inside you, even if your program doesn't require one. On the diabetes front, they both do well, typically seeing 75-85% remission rates (remission is what it is, rather than a "cure" - it can come back, particularly with some weight regain) though the bypass is generally considered to be marginally better. The best results come from the Duodenal Switch which typically shows remission rates in the 98-99% range, but that is a more complex procedure that few surgeons offer. However, if the diabetes fails to go into remission, or comes back, after a VSG, a revision to the DS is straightforward (as the DS uses the VSG as its basis) while revising an RNY to a DS is very complicated, which only a handful of surgeons are able to perform. So, while the VSG may not be quite as good as the RNY in that respect, it has a much more viable "plan B".

There are two types of dumping, early and late. I had plenty of experience with early dumping. Anytime I ate a little bit too much, it would lead to early dumping. Because of this I learned to detect the signals my body gave me to tell me that I was at the edge, such as hiccups, sneezes etc. and then I would just abruptly stop eating not one more bite. But I never experienced high blood pressure or fainting symptoms. There is another type of dumping syndrome called late dumping or reactive hypoglycemia. The following link explains the two types. I met someone with this late dumping condition at a bariatric surgery support group meeting. He was not diabetic prior to surgery but after surgery, he experienced severe reactive hypoglycemia. He even fainted a couple times before he figured out this was a problem. Once he knew the problem, he knew what he had to do whenever he felt dizzy afterwards and found he could easily manage and live with that condition. Dumping Syndrome After Gastric Bypass Surgery But when I looked at your meal, I did not see anything to trigger this reaction. If you had a blood sugar monitor, it might be interesting to know what your blood sugar levels were during your dizzy episodes.