Obesity, Metabolic Disorders, and Bariatric Surgery as a Friend

In this episode I have a conversation with Dr Samer Mattar. Dr Mattar is a bariatric surgeon and director of bariatric surgery at Swedish Medical Center in Seattle, Washington. Additionally, he is the president-elect of the American Society for Metabolic and Bariatric Surgery.

In this episode Dr Mattar shares thoughts on:

  • Why he chose to become a surgeon in general and bariatric surgeon specifically.
  • The future of bariatric surgery.
  • Considerations when trying to help patients navigate their surgical options.
  • Why obesity is more a symptom than a disease.
  • Why a person develops metabolic disorders resulting in obesity.
  • How to help optimize a person prior to bariatric surgery.
  • Insurance-mandated medical weight management as pre-requisite for approval of bariatric surgery.
  • The reason for the gap between those who could benefit from bariatric surgery and those who actually have bariatric surgery.
  • The courage of someone seeking bariatric surgery.
  • The work that remains to be done in helping referring providers establish trust in bariatric surgery and in bariatric surgery programs.
  • Then: Reeger offers some concluding thoughts

Connecting with Reeger: 

WLSP Facebook

In Kindness,


083 Reeger Rambles

by reeger on May 21, 2017


Episode 083

This episode is unique in that I follow a free-form monologue method. I had some thoughts I wanted to share with you and so I decided to simply open the mic and start talking to you. Let me know what you think.
Discussed in this episode:

  • Gratitude to my new Patreon Super Fans
  • Happenings over the past month (photos of the arrow head I found are posted)
  • Thoughts on Obesity Medicine and Bariatric Surgery: Building bridges in care
  • History of Bariatric Surgery and how we’ve come a long way in the quality of our care.
  • WLSFA Conference
  • Does Facebook make us lonelier?
  • A new WLS Friendly Cookbook by Wendy Campbell and Sandi Henderson
  • Elizabeth Anderson, RD (she needs to be a guest on this podcast)
  • Dr Duc Vuong, Bariatric surgeon
  • Is there one Bariatric Program to rule them all?
  • Dr Samer Mattar, Bariatric surgeon (he needs to be a guest on this podcast)
  • Is Obesity a Disease or a Symptom?
  • Should we stop calling obesity a disease and start calling it a Disease of Metabolism instead?
  • Is bariatric surgery similar to organ transplant surgery, gender reassignment surgery, neither, or both?
  • If it is similar to gender reassignment surgery, can we call it Metabolic Reassignment surgery? Or should we call it Opportunity Reassignment surgery?
  • Tell me what you think.

Two jokes exchanged for pocket change

 Connecting with me
WLSP Facebook

In kindness,






episode 82

In this episode I talk with Jerry Ross about his experiences with post-bariatric surgery reactive hypoglycemia. Jerry had Roux-en-Y gastric bypass in 2002 when he was in his early thirties. Although the fact that Jerry had RYGB is central to this story, gastric bypass alone is not the reason Jerry and I recorded this conversation. We talked because Jerry wanted to share his experiences regarding Late Dumping syndrome, aka Reactive Hypoglycemia.


There is a lot of information in this episode so I wanted to give you a chronology of what we talked about and when, just in case you wanted to re-listen to a section and wanted to be able to find it faster than starting over. Happy listening.

Chronology of Topics Discussed
0:22 Reeger Thanks for Patreon supporters.
2:30 Jerry’s history of obesity and decision to have bariatric surgery.
6:35 Thoughts on food addiction.
8:00 Early days after bariatric surgery. The honeymoon period.
9:30 Jerry and exercise right after surgery and his advice to you.
12:30 Jerry’s early weight loss progress, weight regain, and feelings of frustration.
13:30 The tricky thing about hunger- physical hunger vs head hunger.
15:30 Jerry’s journey of testing and evaluation in the first 5-7 years after surgery.
16:50 The surgeons advice to Jerry and Jerry’s thoughts on “getting his head on straight.”
18:00 Jerry’s pre-op and post-op education.
19:20 The beginning of his symptoms of reactive hypoglycemia with a description of what his symptoms were, trying to figure out what was going on, and how he began to manage his symptoms.
27:47 Reeger goes over blood sugar values and symptoms of low blood sugar.
29:12 The Oral Glucose Tolerance Test (OGTT).
32:00 Jerry’s “wake-up call” that his bariatric surgery was not as benign as he once thought and that he could not live like a “normal” person and eat whatever he wanted to eat.
32:30: Reeger describes normal digestion of carbohydrates, blood glucose, gut hormones, insulin, GLP-1.
35:40 Reeger’s disclaimer of gut-endocrine over-simplification and violin metaphor.
36:30 Jerry and Hyperinsulinemic Hypoglycemia and why we call it “Reactive Hypoglycemia.”
38:22 Why might Reactive Hypoglycemia occur after RYGB, the role of GLP-1, and why it tends to get worse over time.
41:20 Nesidioblastosis: What it is and why it might happen after RYGB.
43:00 Acknowledging the frustration of limited understanding why reactive hypoglycemia might occur.
44:16 Incidents of Reactive Hypoglycemia from other bariatric surgeries.
44:50 How to Diagnosis Reactive Hypoglycemia: Blood glucose levels, Whipples triad, Mixed Meal Tolerance Test.
46:20 Excellent paper by Shantavasinkul titled “Post-gastric bypass hypoglycemia: a review”.
47:00 Jerry’s further evaluation and treatment: Food diary, possibility of surgical revisio (Rose procedure, reverse RYGB, partial pancreatectomy).
50:00 Behaviors Jerry changed to help manage his symptoms.
51:00 The foods Jerry now avoids.
53:30 The tricky thing about Jerry’s hunger.
57:00 Struggles with constipation and further weight loss.
58:00 With more weight loss his Reactive Hypoglycemia got even worse and his theory as to why.
1:01 Jerry’s use of a continuous glucose monitor (CGM).
1:04 What Jerry has learned from wearing his CGM.
1:08 Hypoglycemia Unawareness Syndrome.
1:09 A deep dive into treatment: One reference I looked at said that meals and snacks should not exceed 30 grams of carbs, excluding fiber, and some meals can have no carbs at all. Often meals sizes need to be reduced to smaller sizes, eaten more often, 5-6 times per day.
1:10 Understanding Glycemic Index and Glycemic Load.
1:12 Medication Used to treat Reactive Hypoglycemia: Acarbose, Calcium Channel Blockers, Diazoxide, Somatostatin Analogues.
1:14 Surgical Options: Partial pancreatectomy, Reversal of the RYGB, or placement of a gastric feedling tube.
1:15 An additional thought on the work-up of Reactive Hypoglycemia: Insulinoma.
1:16 The medication that did work for Jerry: GLP-1 receptor agonist.
1:18 Reeger’s pondering why a GLP-1 receptor agonist might given and Jerry helping explain how the medication has helped him.
1:22 Reeger goes back to the violin metaphor.
1:23 The GLP-1 agonist medications available: Exenatide (Byetta or Bydureon), Albiglutide (Tanzeum), Dula-glutide (Trulicity), Lixisenatide (Lyxumia), and Liraglutide (Victoza, and as an obesity medication it is sold under the name Saxenda). It should be noted, that using any of these GLP-1 agonist medications to treat Post-bariatric surgery reactive hypoglycemia would be considered an off-label use, so prescriber beware.
1:24 Jerry’s new normal of health.
1:25 Does Jerry regret having had RYGB?
1:26 Reeger talks about caring for patients who have presented in the office with symptoms of reactive hypoglycemia.
1:29 Reeger’s concluding thoughts.
1:32 Bonus Content.

Connecting with Jerry
Instagram ChunkyBoySlim

Connecting with Reeger
WLSP Facebook

In Kindness,



081 Moving Forward with Laura Van Tuyl

March 19, 2017

In this episode I have a conversation with Laura Van Tuyl. April, 2017 is Laura’s 14th Barisurgaversary for having Roux-en-Y Gastric Bypass. We talk about many aspects of her journey but some of the highlights include her thoughts of how being a very picky eater as a child contributed in part to her eating habits as […]

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080 They Didn’t Staple My Brain- A conversation with Dr Janine Kyrillos

February 13, 2017

In this episode I have a conversation with Dr Janine Kyrillos. Dr Kyrillos is Clinical Assistant Professor of Medicine at Jefferson Medical College in Philadelphia, Pennsylvania and she is Director of Jefferson Comprehensive Weight Management Program at Bala Cynwyd, Pennsylvania. She is also someone who herself is affected by obesity and has undergone Roux-en-Y Gastric […]

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079 Bariatric Surgery Seminar as a Podcast

January 9, 2017

Happy New Year everyone! In this episode I bring you a podcast version of the bariatric surgery seminar I give twice monthly at Southern Oregon Bariatric Center. This version is more generic to bariatric surgery in general because my intent is not to tell you specifics about SOBC, but rather introduce you to important concepts […]

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078 Gathering Knowledge with Amy Swayzee

December 11, 2016

In this episode I talk with Amy Swayzee who had gastric sleeve in May of 2015. We talk about her life before bariatric surgery, how she came to the realization that bariatric surgery was not cheating or the easy way, and that if she was finally going to bring her weight under control perhaps she […]

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076 What to Eat with Sarah Muntel, RD

October 16, 2016

In this episode I bring you my conversation with registered dietician, Sarah Muntel. Sarah has been a registered dietician in bariatric surgery for over 17 years. She brings a wealth of information and education to you in this episode. Covered in this episode: Sarah’s role as a registered dietician and program coordinator Pre-surgery nutrition plans […]

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075 Bariatric Surgery Rules? A talk with Dr Walter Medlin

September 11, 2016

In this episode I have a conversation with Dr. Walter Medlin about bariatric surgery rules. You may remember Dr. Medlin from episode 53. He is a bariatric surgeon at the Bariatric Medicine Institute in Salt Lake City, Utah. He is also a bariatric surgery patient having had sleeve gastrectomy. During this conversation Dr Medlin and I […]

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074 (Unedited) Set Point, Biology, Environment & Obesity: An Interview with Dr Randy Seeley

August 8, 2016

What you are about to hear is the unedited version of my most popular episode to date: Episode 34, titled “Set Point, Biology, Environment & Obesity: An Interview with Dr Randy Seeley.” I first published the edited version of this conversation on August 17th 2014. Over the past two years that episode has had the […]

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073 How to Choose a Bariatric Surgery Program with John Bukenas

July 12, 2016

In this episode I welcome back John Bukenas. We explore how to choose a bariatric surgery program. If you are new to the podcast, John and I have talked about his obesity and the possibility of bariatric surgery in episodes 26 and 45. Topics discussed in the episode John’s struggles and declining health First Step: […]

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072 “Hey Reeger..,” A Letter from a Listener

June 17, 2016

Welcome to the weight loss surgery podcast where we talk about obesity and bariatric surgery one episode at a time. I’m your host, family nurse practitioner, Reeger Cortell. This episode is brought to you by you, my listeners. I am so touched by the love you show me, whether that is iTunes rates, sharing the […]

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071 Jeff Newell: On Gaining a New Life

May 31, 2016

In this episode Jeff Newell returns to the podcast to catch us up on his life since having Roux-en-Y Gastric Bypass on 12/1/2014. Jeff has been on the podcast before on episodes 055, 049, 043, and 042. He is now 18 month out from his surgery and 300 pounds down from his pre-surgery weight of […]

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070 Reeger Cortell FNP: An Interview by Rob Portinga

May 9, 2016

Presenting Your Host, Reeger Cortell, FNP Over the last 18 months or so, I, Rob Portinga, have had the pleasure of going from being a guest, to being a contributing host on the Weight Loss Surgery Podcast (WLSP). It was started by Reeger Cortel, FNP nearly three years ago now. One of the driving themes, and […]

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069 Talking about the Fear Factors of Bariatric Surgery with Dr Raul Rosenthal

April 17, 2016

My guest today is Dr Raul Rosenthal. Dr Rosenthal works at the Cleveland Clinic Florida in Weston Florida, where he is a bariatric surgeon, chief of surgery, chief of staff, and the director of the Cleveland Clinic Florida Metabolic and Bariatric Institute. In addition to all those good works, he is also the current president of […]

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068 Understanding Lipedema with Sarah Bramblette and Karen Herbst, MD, PhD

March 15, 2016

In this episode I bring you my conversation with Sarah Bramblette. As you are about to hear, Sarah is many things but above all she is an inspirational mix of hardwork, intelligence, grit, compassion, and determination. She is everything you would want in a loved one, a friend, a daughter, and an obesity advocate. Sarah’s […]

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067 The Bariatric Surgeon Episode

February 20, 2016

In this episode I bring you my interviews with six different bariatric surgeons. I conducted these interviews while I was at ObesityWeek in Los Angeles, CA in November 2015. I asked each surgeon one or two of the following questions: How do you help people decide which surgery to choose? And, If you could wave […]

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066 Connie Stapleton, PhD- Healing Your Relationship with Yourself

January 25, 2016

In this episode I bring you my conversation with clinical psychologist, Connie Stapleton, PhD. Dr Stapleton has been working in the field of bariatric surgery for 11 years and as you would image, and are about to hear, she has a wealth of information and insight and information to share with you. Discussed in this […]

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065 After the After with Nikki Massie

January 2, 2016

In this episode, I bring you my conversation with Nikki Massie. Nikki is many things within the bariatric surgery community including a bariatric surgery patient who had Roux-enY Gastric Bypass in 2008, the creator of the ever popular website Bariatric Foodie where she encourages you to “play with your food,” a prolific blogger, a storyteller, a […]

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064 Scott Monte, PharmD on Medications Just Before and Just After Bariatric Surgery

December 6, 2015

  In this episode I bring you my conversation with pharmacist, Scott Monte, PharmD. I met Scott at the 2015 Obesity Week conference in Los Angeles. Since 2009 Scott has worked as a pharmacist with the bariatric surgery program known Synergy Bariatrics in Buffalo, NY. After talking with him at the conference I knew I […]

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