4 Years Post Gastric Bypass – Major Problems With Carbs/ Sugar/ Dumping/ Lethargic

Question Below Submitted By:  

Ross (a patient from San Jose, Ca)

Hello everyone.

I’m looking to get feedback on my story and hoping that other gastric bypass patients have had similar issues and can offer some advice. The backstory is I had always battled weight most of my life but when I turned 17 I finally was able to get a hold of it and lost all my weight naturally and then held onto that health for most of my life fluctuating periodically 20 pounds up and down. But when I had my first son at age 34 and changed my job to a sedentary, non-active position with a lot of stress and I began to gain weight rapidly.

In approximately a four-year period of time I put on a huge amount of weight and eventually ended up at 375 pounds at 5 feet 11 inches. So, after years of battling that weight and having episodes of success and even losing 100 pounds at one point using the low carb diet (really the no carb diet) all the weight came back on and at age 48 I realized that my body chemistry had slowed down so much that losing weight was so difficult that I doubted my ability to be able to do it naturally anymore.

I had considered weight loss surgery in the past but I guess my ego had prevented me from using that route. The realization that my body was not losing weight like it had previously when I was younger was a difficult blow and forced me to consider weight loss surgery as a viable option. Our medical coverage was Kaiser Permanente and my weight loss surgeon wanted me to lose 10% before the surgery to prove I could handle the surgery diet requirements but in fact I lost 60 lbs prior to the surgery.

After the surgery I lost the majority of my weight in approximately a year with a few pounds more within the next couple of months. I hit my goal weight of 175, thus losing almost 200 lb from my start, in less than a year-and-a-half. From the beginning after the surgery my hunger had really disappeared and eating was problematic unless it was soft and mushy.

Eating is still semi difficult to this day. I have maintained my weight loss but here is the heart of the story… approximately two years after the weight loss surgery I started having an unusual symptom that has intensified and continued to get worse. When I started waking up in the early morning to go to work I started noticing that I was incredibly tired and it was very difficult for me to get out of bed and get going. I had to consume huge amounts of caffeine to wake myself up and shake the lethargic cloud that hung over me. Let me preface this by saying I, like most gastric bypass patients, have intimate knowledge of dumping syndrome and and all its wonderful symptoms (light spots, confusion, cold sweats, etc, etc). This was different and did not match the typical dumping syndrome symptoms.

Right before bed or during the middle of the night I would wake up craving peanut butter and crackers or something similar and go back to sleep. In the morning I would wake up with basically a hangover, as if I had been drinking all night. I was exhausted, had a headache, intensly lethargic and tired and felt drugged like you do if you take a lot of benedryl, deep brain fog, blurred vision, and terrible memory.

Apparently during the night my subconscious took me out and we had a crazy time in Vegas.

During waking hours if I eat anything similar to the above, regardless if I front load protein, it will anesthetize me and I will need to fall asleep. Now, I’ve become intensely super, hypersensitive to carbohydrates including carbohydrates from vegetables, raw or cooked. Yes the doctors gave me a blood sugar kit to take home to test for hypoglycemia or reactive hypoglycemia but I have yet to get a blood sugar reading below 70 when these episodes hit so the doctors are perplexed and not very helpful as to what is going on.

Weight loss surgery patients for the most part have a limited food selection but mine has become so small it’s scary and frustrating. I seem to only be able to handle protein and limited amounts of raw high fiber vegetables. Based upon my symptoms you would think that I fall into reactive hypoglycemia or maybe some kind of variant of late dumping syndrome, or NIPHS, but my blood sugar readings don’t indicate issues. There are a few articles about former weight loss surgery patients having symptoms of reactive hypoglycemia without their blood sugar dropping below 60 but nothing definitive.

Last night I had a low carb hamburger with lettuce as the bun, mayonnaise, two dill pickles, and two slices of tomato, which sent me into an ugly dumping episode where the culprit had to be the slices of tomato (nausea, anxiety, cold sweats, overall sick feeling ).

To be honest, I can handle the dumping, but the day after day onslaught of waking up hungover regardless of what I eat unless it’s straight protein has derailed my life. During the day, if I eat carbs, I fall asleep, and at night if I eat carbs and go to bed I wake up feeling like I got hit by a truck in the middle of the night.

If anyone has any insight or a similar experience please respond. Thank you and my apologies for the long story.

Sincerely, Ross

Bariatric Surgery Source

Expert Responses to the Question Above

Surgeon Response to "4 Years Post Gastric Bypass Surgery - Major Problems"

by: John Rabkin, M.D., Pacific Laparoscopy

Dear Ross,

You have certainly attempted to 'turn over every stone' in your effort to identify the source of your symptoms. At first blush, your experience does seem to at least mimic the post Roux-en-Y Gastric Bypass (RGB) associated dumping physiology. The types of ingested calories associated with your symptoms that you outline fit with that assessment.

However, there are alternative etiologies worth considering which may also be impacting your symptom complex.

First off the bat would include post RNY mineral deficiencies: if you haven't recently already had a thorough serum chemistry panel performed inclusive of the trace minerals malabsorbed after a RNY, I would promptly obtain those laboratory values. If you have difficulty obtaining a list of those laboratory tests, you can obtain the list from my website, Pacific Laparoscopy.

You also didn't mention whether or not you had (or have) Obstructive Sleep Apnea (OSA). Should there be any question in your case, undergoing a formal sleep study is recommended.

Another avenue to potentially pursue would be a gastrointestinal motility disorder. An evaluation by a neurogastroenterologist (gastroenterologists who specialize in the evaluation and treatment of these types of disorders) may be of benefit to you. If you still have your gallbladder, an ultrasound looking for gallstones would be advised if not already performed: if found, I'd recommend that you have a cholecystectomy (gallbladder removal surgery.)

A HIDA (radionucleotide biliary scan) sometimes demonstrates abnormal retrograde reflux of bile into the excluded stomach after the RNY; this could also be responsible for some of your deleterious symptoms. Also, undergoing an abdominal Computerized Tomopgraphy (CT) scan with a pancreatic protocol looking for a potential pancreatic neuroendocrine tumor as a contributing factor may unveil an unusual reason (pNET tumor) occasionally associated with the RNY for your symptoms.

At the 'end of the day,' after undergoing an extensive evaluation as outlined above which, ultimately, unfortunately proves unrevealing, it may be that you are simply 'intolerant' of the RNY anatomy and associated physiology. If your symptoms are sufficiently debilitating, you may want to consider a reversal of your RNY. In this situation, I routinely recommend that my patients be simultaneously converted to a Duodenal Switch (DS.)

In my experience in this situation, patients have universally experienced an improvement in their presenting symptoms and more than three quarters of them report complete resolution of these symptoms. Most importantly, they also enjoy a substantial improvement and liberalization of their dietary intake and overall lifestyle without a risk of weight regain!

Best regards,

John M. Rabkin, M.D.
Pacific Laparoscopy

(click here for Dr. Rabkin's full bio & contact info)

DISCLAIMER: This educational advice is based on the depth of your question and the details provided. The above should never replace the advice of your local physicians as they have the ability to evaluate you in person.

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