The number of gastric bypass surgeries performed each year is on the rise. Some people undergo the procedure to lose weight and prevent type 2 diabetes. Others have it done to treat the disease. While having gastric bypass surgery often reverses diabetes, it may hike your chances of developing extreme blood-sugar drops, called hypoglycemia.
Gastric bypass can result in metabolic changes that cause excess insulin production, says Mary-Elizabeth Patti, M.D., F.A.C.P., Director of the Hypoglycemia Clinic at Joslin Diabetes Center. “People secrete more insulin than they should after eating. Glucose levels spike after a meal and then decline too low. This roller coaster pattern of repeated low blood sugars can take a toll on your system.”
In fact, post bariatric hypoglycemia (blood sugar below 70 mg/dL) may trigger problems such as fatigue, confusion or even seizures. The lows come on so quickly and drop so low that cognitive function is impaired. You may even pass out. But for most people the symptoms aren’t that obvious. As a result, the true number of people with this complication is not known.
Fortunately, once the complication is diagnosed, it can usually be treated. Medications prescribed to reduce carbohydrate absorption and insulin secretion are helpful, but they are incompletely effective in reducing the severity and frequency of this complication, says Dr. Patti.
Dietary changes are the first step for treating hypoglycemia. “My estimate is that 50 percent of people referred to the Hypoglycemia Clinic here at Joslin do well on diet alone and the other 50 percent need additional medication added to diet,” she says.
After seeing their patients’ lives change for the better, Emmy Suhl, M.S., R.D., C.D.E., and colleagues at the Hypoglycemia Clinic wanted to come up with effective nutritional recommendations for others to follow. We see people who have been suffering with this for years, says Suhl. “So we wanted to design an eating program that doesn’t cause a rapid increase in blood glucose, because it’s the high blood sugar that kicks off the low.”
Therefore, they reviewed all the previously published data on post bariatric hypoglycemia as well as their own extensive clinical experience. The result: practical nutrition guidelines for physicians, healthcare providers and patients published in the January issue of Surgery for Obesity and Related Disease.
The 10 best measures are to control portions of carbohydrate (30 grams per meal, 15 grams per snack); choose low-glycemic index carbohydrates; avoid high-glycemic index carbohydrates; include heart-healthy fats in each meal and snack; get adequate protein intake; space meals three hours apart; avoid consuming liquids with meals and chew slowly; avoid alcohol; avoid caffeine; and take nutritional supplements to prevent nutrient deficiencies.
Importantly, all of these 10 recommendations need to be done simultaneously. ‘If you do just one, two or even five of these nutrition steps, it’s unlikely to work, says Suhl. “So if you do all nine of these things, but you drink alcohol, you could set off a low blood sugar reaction.”
Many people are motivated do whatever it takes because they are debilitated by the symptoms. Still, the plan can be challenging to implement. “Changing how you eat is always difficult when you have diabetes or hypoglycemia because our environment is always working against us,” says Dr. Patti. “Essentially, healthy eating has to become the norm.”
An important part of therapy is education about better, healthier ways to eat. In basic terms, this means learning to decode food labels and identifying hidden sugars lurking in foods. Juice is a good example. Although it comes from a healthy food product, it’s not a good choice when you are trying to limit carbohydrates which are quickly absorbed. You’re better off eating an orange or an apple.
Diabetes is the most common disorder of metabolism. It is a condition where glucose is higher than normal. The other end of that spectrum is hypoglycemia, says Dr. Patti, but this particular complication is often ignored.
Our paper underscores the point that dietary approaches are the most important first step, she says. “We can usually find a combination of meal plan and medications to control hypoglycemia; we no longer recommend any pancreatic surgery for this condition.”