Hypoglycemia is a potential issue after bariatric surgery due to changes in gut hormones and insulin sensitivity from weight loss. Symptoms range from mild like hunger to more severe issues like seizures. To manage low blood sugar, it is important to pair complex carbohydrates with protein. Fiber sources like guar gum and pectin found in fruits and vegetables can help prevent dumping syndrome and stabilize blood glucose levels by slowing digestion. A daily 10-15 gram fiber target from these sources is recommended.

1. Managing Post Bariatric Surgery Hypoglycemia
WhatisHypoglycemiaExactly?
Hypoglycemiaistheloweringofbloodglucoselevelsbelowournormalrange.Whilethe cause
inbariatric patientsis stillupfordebate,itis believedthatdumpingsyndrome,theincreasein
insulinsensitivitythatcomeswithweightloss,aswellaschangingguthormonescould all
contributeto thisdropinbloodglucose.
SymptomsandLevelsofSeverity
Glucoseisvitalforpropertissueandbrainfunctioning(thebraincanonlyuseglucoseasan
energysource!) soitisveryimportantthatwelookoutforanysignsoflowbloodsugar!
Therearedifferentlevelsofhypoglycemia,soitis criticaltobefamiliarwiththesymptoms:
Light
(BloodGlucose ~75mg/dL)
 Hunger
 Headache
 Break outin Sweat
 Clammy Hands
 Increased Heart Rate
Moderate
(BloodGlucose ~40-74 mg/dL)
 Headache
 Anxiety
 Blurry Vision
 Nausea
Severe
(BloodGlucose ~0-39 mg/dL)
 Dizziness
 Fatigue
 Irritable
 Fainting/Unconsciousness
 Seizures/ Convulsionshttp://www.weightlosssurgery.ca/before-after-surgery/reactive-hypoglycaemia-post-gastric-bypass/

2. Managing Post Bariatric Surgery Hypoglycemia
WhatshouldI doifit happenstome?
Complex carbohydrates canact quicklytobumpupbloodglucose,while protein is
great forstabilizing bloodglucoseover a lengthoftime. Choosing highfiber foodscan
helpminimize spikes as well. With thisin mind,it isimportant topair ahighprotein and
a complex(notsimple!) carbohydratesource whendealing withhypoglycemia:
Do notchoosesimplesugars (candies,pop,etc.)becausetheycancausebloodglucose
levelstospiketooquickly,drivinganotherlow!
Do notconsume caffeineoralcoholduringabloodsugarlow,asthesecanworsenthe
hypoglycemia!
*ExtendBars are made withuncookedcornstarch, avery longacting carbohydratewith
a lowglycemic index whichwouldbe agreat optionto always have onhandin case you
are experiencing recurrent hypoglycemia.
WhatcanI dotopreventlowbloodsugar?
Complex Carbohydrates (15gram target)
Fruit!
1Banana (12.4grams)
1Apple(14.1grams)
½cupApplesauce (13.5grams)
1/2Pita Bread (20grams)
½cupFat Free Mashed Potatoes(17.8g)
Fruit Juice ifSevere Hypoglycemia
Protein
Nuts Peanut Butter
Kind Bars ProteinShakes/Bars
Beans Jerky/Meats
Eggs Wendy’sChili
Yogurts Hummus
Cheeses Tuna
*ExtendBar Milk

3. Managing Post Bariatric Surgery Hypoglycemia
 Carry a glucometer withyouand checkbloodsugar before andafter meals.
 Keep foodlogsandlookfor trends!
 Eat lowcarbohydrate,highproteinmeals. Proteinis great atkeepingblood
glucose stable!
 Eat small portions,frequently.
 Have “emergency” foodsinyour car,bag,oreasy toaccess places incase ofa
hypoglycemic episode.(see foodsabove)
So,whatareGUARGUMSandPECTINS?
Mostof youeat someform ofa guar gumorpectin every single day anddon’t even know
it! Have youever eaten an apple? Maybe somesoymilk or ajam? Most fruits,vegetables,
anda variety ofdairy productsare doingyourbodyagreat service because theyare rich
in gumsandpectin!
These soluble,dietary fibers are gel- forming withintheGI tract,whichmeans they are
great atabsorbingwater efficiently, becoming aviscous gel,andbindingwithother
carbohydrates withintheGItract. Ultimately, theyhelpto slow gastricemptying and
leave you feeling full. They are greatfor avoiding dumpingsyndrome,moderating
cholesterol levels andstabilizing bloodglucose (becausethey delaythe absorptionof
glucose!).
GuarGums-comesfromthemilling of guarseeds andis commonly used asa food
additive andthickening agent;foundina variety of foodproducts:soymilkanddairy
products,jams,juices, soups,salad dressings, packagedfoods…andthe list goeson.

4. Managing Post Bariatric Surgery Hypoglycemia
*Ifdiabetic: “Largeamounts ofguar gum(10gor more daily)may decrease metformin
serum concentrations and should beavoided.”
Pectin-foundintheskins(specifically thecell walls) of plants.Primary source ofpectin
is in fruits, vegetables andlegumes. In fact,according totheUSDA,fruitsare made upof
5-10%pectin while vegetables andlegumes are composed of15-20%pectin! Pectin is
also usedas a thickeningagent andcan befoundin jellies andjams.
HowmuchshouldItakeeveryday?
 A10-15 gram perdaytarget is suggested foravoiding bothhypoglycemiaand
dumpingsyndrome. (10-15 grams is equivalent to2-3teaspoons ofsoluble fiber).
 Trysplitting the10-15 grams intotwoorthree,lower doses throughouttheday.
For example, 3,5gram doses.
 Ifthese foodscause excessive flatulence, nausea, or diarrhea, reduce your
dosage,as needed,butstill keepthosefluids up!

5. Managing Post Bariatric Surgery Hypoglycemia
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forChildren? Karen Ranzi M.A.SuperHealthyChildren. October2013.
http://superhealthychildren.com/what-is-guar-gum-and-can-this-common-food-
additive-cause-digestive-problems-for-children/
Guar Gum.Drugs.comCopyright 2000-2015.
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TheSupplement Handbook:ATrustedExpert's GuidetoWhatWorks& What's
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6. Managing Post Bariatric Surgery Hypoglycemia
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Licking SweetDeath:Energyand Information toStopSugarcoatingYourAddiction
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